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Allar BG, Torres M, Mahmood R, Ortega G, Himmelstein J, Weissmann L, Sheth K, Rayala HJ. Unique Breast Cancer Screening Disparities in a Safety-Net Health System. Am J Prev Med 2024; 66:473-482. [PMID: 37844709 DOI: 10.1016/j.amepre.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Breast cancer screening (BCS) disparities leave historically underserved groups more vulnerable to adverse outcomes. This study explores granular associations between BCS and patient sociodemographic factors in a large urban safety-net health system. METHODS A retrospective review among female patients ages 50-74 within an urban safety-net health system was conducted in 2019. All patients had a primary care visit in the past 2 years. Multiple patient health and sociodemographic characteristics were reviewed, as well as provider gender and specialty. Bivariate analyses and multivariable logistic regression were performed in 2022. RESULTS The BCS rate among 11,962 women was 69.7%. Over half of patients were non-White (63.6%) and had public insurance (72.3%). Patients with limited English proficiency made up 44.3% of the cohort. Compared to their sociodemographic counterparts, patients with White race, English proficiency, and Medicare insurance had the lowest rates of BCS. Serious mental illness and substance use disorder were associated with lower odds of BCS. In multivariable analysis, when using White race and English speakers as a reference, most other races (Black, Hispanic, and Other) and languages (Spanish, Portuguese, and Other) had significantly higher odds of screening ranging from 8% to 63% higher, except Asian race and Haitian Creole language. Female (versus male) and internal medicine-trained providers were associated with higher screening odds. CONCLUSIONS Multiple unique variables contribute to BCS disparities, influenced by patient and health system factors. Defining and understanding the interplay of these variables can guide policymaking and identify avenues to improve BCS for vulnerable or traditionally under-resourced populations.
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Affiliation(s)
- Benjamin G Allar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Micaela Torres
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Rumel Mahmood
- Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica Himmelstein
- Department of Internal Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Lisa Weissmann
- Department of Hematology/Oncology, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Ketan Sheth
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Heidi J Rayala
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts; Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Vadaparampil ST, Fuzzell LN, Brownstein NC, Fontenot HB, Lake P, Michel A, McIntyre M, Whitmer A, Perkins RB. A cross-sectional survey examining clinician characteristics, practices, and attitudes associated with adoption of the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines. Cancer 2023; 129:2671-2684. [PMID: 37221653 DOI: 10.1002/cncr.34838] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) risk-based management consensus guidelines are the most recent national guidelines for the management of abnormal cervical cancer screening tests. These guidelines benefit patients by concentrating testing and treatment in those at highest cervical cancer risk. Adoption of guidelines often occurs slowly, with few studies examining the factors associated with guideline-adherent management of abnormal results. METHODS To elucidate the factors associated with the use of the 2019 ASCCP guidelines among clinicians who perform cervical cancer screening, physicians and advanced practice professionals who perform cervical cancer screening were cross-sectionally surveyed. Clinicians responded to screening vignettes with differing recommendations for management between the 2019 and prior management guidelines. Screening vignette 1 involved reduction of invasive testing on a low-risk patient; screening vignette 2 involved increased surveillance testing on a high-risk patient. Binomial logistic regression models determined the factors associated with the use of the 2019 guidelines. RESULTS A total of 1251 clinicians participated from across the United States. For screening vignettes 1 and 2, guideline-adherent responses were given by 28% and 36% of participants, respectively. Management recommendations differed by specialty and were incorrect in different situations: there was inappropriate invasive testing by obstetrics and gynecology physicians (vignette 1) and inappropriate discontinuation of screening by family and internal medicine physicians (vignette 2). Regardless of their chosen response, over half erroneously believed they were guideline adherent. CONCLUSIONS Many clinicians who believe they are following appropriate guidelines may not realize their management strategy is inconsistent with the 2019 guidelines. Education initiatives tailored to clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms. PLAIN LANGUAGE SUMMARY The 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines are the most recent national guidelines for abnormal cervical cancer screening test management. We surveyed over 1200 obstetrics and gynecology (OB/GYN), family medicine, and internal medicine physicians and advanced practice providers about their screening and abnormal results follow-up practices in relation to guidelines. Few clinicians are following the 2019 guidelines. Management recommendations differed by clinician specialty and were incorrect in different situations: there was inappropriate invasive testing by OB/GYN physicians and inappropriate screening discontinuation by family and internal medicine physicians. Education tailored by clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms.
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Affiliation(s)
- Susan T Vadaparampil
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Lindsay N Fuzzell
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Naomi C Brownstein
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Holly B Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Paige Lake
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Alexandra Michel
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - McKenzie McIntyre
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Ashley Whitmer
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Rebecca B Perkins
- Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
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Fuzzell L, Brownstein NC, Fontenot HB, Lake PW, Michel A, Whitmer A, Rossi SL, McIntyre M, Vadaparampil ST, Perkins RB. Examining the association of clinician characteristics with perceived changes in cervical cancer screening and colposcopy practice during the COVID-19 pandemic: a mixed methods assessment. eLife 2023; 12:e85682. [PMID: 37656169 PMCID: PMC10473834 DOI: 10.7554/elife.85682] [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: 12/20/2022] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
Background The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed method study we explored perceived pandemic-related practice changes to cervical cancer screenings and colposcopies. Methods In 2021, a national sample of 1251 clinicians completed surveys, including 675 clinicians who performed colposcopy; a subset (n=55) of clinicians completed qualitative interviews. Results Nearly half of all clinicians reported they were currently performing fewer cervical cancer screenings (47%) and colposcopies (44% of those who perform the procedure) than before the pandemic. About one-fifth (18.6%) of colposcopists reported performing fewer LEEPs than prior to the pandemic. Binomial regression analyses indicated that older, as well as internal medicine and family medicine clinicians (compared to OB-GYNs), and those practicing in community health centers (compared to private practice) had higher odds of reporting reduced screening. Among colposcopists, internal medicine physicians and those practicing in community health centers had higher odds of reporting reduced colposcopies. Qualitative interviews highlighted pandemic-related care disruptions and lack of tracking systems to identify overdue screenings. Conclusions Reductions in cervical cancer screening and colposcopy among nearly half of clinicians more than 1 year into the pandemic raise concerns that inadequate screening and follow-up will lead to future increases in preventable cancers. Funding This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.
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Affiliation(s)
- Lindsay Fuzzell
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | | | - Holly B Fontenot
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - Paige W Lake
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Alexandra Michel
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - Ashley Whitmer
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Sarah L Rossi
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - McKenzie McIntyre
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
- H. Lee Moffitt Cancer Center & Research Institute, Office of Community Outreach, Engagement, and EquityTampaUnited States
| | - Rebecca B Perkins
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
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Hosier H, Sheth SS, Oliveira CR, Perley LE, Vash-Margita A. Unindicated cervical cancer screening in adolescent females within a large healthcare system in the United States. Am J Obstet Gynecol 2021; 225:649.e1-649.e9. [PMID: 34256029 DOI: 10.1016/j.ajog.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/25/2021] [Accepted: 07/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Current consensus recommendations are to not initiate cervical cancer screening for immunocompetent adolescent females before 21 years of age. This is in part because of the very low rate of 0.8 per 100,000 new cervical cancer cases diagnosed among women aged between 20 to 24 years. Timely human papillomavirus vaccination further decreases the incidence of cervical cancer to 4 cases per 100,000 persons by the age of 28 years. Screening before 21 years of age has demonstrated no clear benefit in cancer risk reduction or outcomes. In addition, unindicated screening among adolescents can lead to patient harm and increasing costs to the healthcare system. OBJECTIVE It is important to assess the rates of overutilization of cervical cancer screening and to identify areas where improvements have occurred and where further opportunities exist. This study aimed to assess the trends over time and the practice and provider factors associated with unindicated cervical cancer screening tests in adolescent females within the largest healthcare system in the state. STUDY DESIGN Cross-sectional data from patients aged 13 to 20 years who underwent cervical cancer screening between January 1, 2012, and December 31, 2018, across a large multihospital health system were reviewed. All cervical cancer screening results were included. The incidence rate of unindicated screening was analyzed over 6-month intervals using the Poisson regression analysis. RESULTS The study included data from 118 providers and 794 women. Among the 900 screening results, most (90%) were unindicated: 87% with unindicated cytology testing alone and 14% with unindicated human papillomavirus testing. Screening tests were collected from patients aged 13 to 20 years, many of whom had multiple unindicated cytology tests, with 25 patients having ≥3 tests before the age of 21 years. Most results of cytology testing were negative for intraepithelial lesion or malignancy (77%). Moreover, 52 invasive diagnostic or therapeutic procedures (49 colposcopies and 3 conizations) were performed, of which 45 (87%) followed an unindicated screening test. Between 2012 and 2018, the incidence rate of unindicated cytology decreased by 33% (12.6 to 8.5 unindicated cytology per 1000 encounters). The incidence rate of unindicated screening was lower in the academic setting than in the community setting (incidence rate ratio, 0.43; P<.01). Even with decreases in the overall rates of unindicated screening throughout the study period, there were still 58 unindicated screening tests performed in the final year of this study. CONCLUSION Despite substantial reductions in unindicated screening for women aged <21 years, there remained areas for improvement. Our data reflected practices of guideline nonadherence up to 7 years after the 2012 guideline. Now, with a new series of changes to the guidelines, which may be even more challenging for patients and providers, it is more important than ever to utilize evidence-based strategies to improve guideline dissemination and adherence.
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Zeng ZL, Zhu Q, Zhao Z, Zu X, Liu J. Magic and mystery of microRNA-32. J Cell Mol Med 2021; 25:8588-8601. [PMID: 34405957 PMCID: PMC8435424 DOI: 10.1111/jcmm.16861] [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] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/25/2021] [Accepted: 08/02/2021] [Indexed: 12/11/2022] Open
Abstract
MicroRNAs (miRNAs) are a group of endogenous, small (∼22 nts in length) noncoding RNA molecules that function specifically by base pairing with the mRNA of genes and regulate gene expression at the post-transcriptional level. Alterations in miR-32 expression have been found in numerous diseases and shown to play a vital role in cell proliferation, apoptosis, oncogenesis, invasion, metastasis and drug resistance. MiR-32 has been documented as an oncomiR in the majority of related studies but has been also verified as a tumour suppressor miRNA in conflicting reports. Moreover, it has a crucial role in metabolic and cardiovascular disorders. This review provides an in-depth look into the most recent finding regarding miR-32, which is involved in the expression, regulation and functions in different diseases, especially tumours. Additionally, this review outlines novel findings suggesting that miR-32 may be useful as a noninvasive biomarker and as a targeted therapeutic in several diseases.
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Affiliation(s)
- ZL Zeng
- The First Affiliated HospitalDepartment of Metabolism and EndocrinologyHengyang Medical SchoolUniversity of South ChinaHengyangChina
- The First Affiliated HospitalDepartment of Clinical MedicineHengyang Medical SchoolUniversity of South ChinaHengyangChina
- Key Laboratory for Arteriosclerology of Hunan ProvinceDepartment of Cardiovascular DiseaseHengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Qingyun Zhu
- The First Affiliated HospitalDepartment of Metabolism and EndocrinologyHengyang Medical SchoolUniversity of South ChinaHengyangChina
- The First Affiliated HospitalDepartment of Clinical MedicineHengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Zhibo Zhao
- The First Affiliated HospitalDepartment of Metabolism and EndocrinologyHengyang Medical SchoolUniversity of South ChinaHengyangChina
- The First Affiliated HospitalDepartment of Clinical MedicineHengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Xuyu Zu
- The First Affiliated HospitalDepartment of Metabolism and EndocrinologyHengyang Medical SchoolUniversity of South ChinaHengyangChina
- The First Affiliated HospitalDepartment of Clinical MedicineHengyang Medical SchoolUniversity of South ChinaHengyangChina
| | - Jianghua Liu
- The First Affiliated HospitalDepartment of Metabolism and EndocrinologyHengyang Medical SchoolUniversity of South ChinaHengyangChina
- The First Affiliated HospitalDepartment of Clinical MedicineHengyang Medical SchoolUniversity of South ChinaHengyangChina
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Liu Y, Wang Y, Shen X, Chen C, Ni H, Sheng N, Hua M, Wu Y. Down-regulation of lncRNA PCGEM1 inhibits cervical carcinoma by modulating the miR-642a-5p/LGMN axis. Exp Mol Pathol 2020; 117:104561. [PMID: 33121976 DOI: 10.1016/j.yexmp.2020.104561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/30/2020] [Accepted: 10/23/2020] [Indexed: 02/08/2023]
Abstract
LncRNA PCGEM1 (PCGEM1) has been reported to exert essential effects on the development and progress of various tumors, while the detailed effects and possible mechanisms of PCGEM1 in cervical carcinoma remain unknown. In the present study, PCGEM1 was over-expressed in cervical carcinoma cells as evidenced by real-time quantitative polymerase chain reaction (RT-qPCR) assay. Knockdown of PCGEM1 significantly repressed proliferation, migration, and invasion, while induced G1 arrest in cervical carcinoma cells. In addition, PCGEM1 was predicted to target miR-642a-5p by bioinformatics software, which was further confirmed by luciferase reporter assay. Besides, RT-qPCR assay indicated that miR-642a-5p expression was decreased in cervical carcinoma cells and knockdown of PCGEM1 could accelerate miR-642a-5p expression. Moreover, inhibition of miR-642a-5p partly abolished the functions of PCGEM1 knockdown on proliferation, cell cycle, migration and invasion of cervical carcinoma cells. Furthermore, miR-642a-5p could bind to the 3'-UTR of LGMN, which was over-expressed in the cervical carcinoma cells. Suppression of LGMN partly restored the functions of miR-642a-5p inhibitor on proliferation, cell cycle distribution, migration and invasion in the cervical carcinoma cells treated with the PCGEM1 shRNA. Taken together, our data indicated that knockdown of PCGEM1 inhibited proliferation, migration and invasion in cervical carcinoma by modulating the miR-642a-5p/ LGMN axis.
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Affiliation(s)
- Yuanlin Liu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong 226001, China.
| | - Ye Wang
- Shanghai Hanghua International Shipping Agency Co. LTD, Shanghai, China
| | - Xiang Shen
- Department of Stomatology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Chen Chen
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Huihua Ni
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Nan Sheng
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Minhui Hua
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Yanling Wu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong 226001, China
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Kervella L, Berveiller P, Bourdillon M, Rousseau A. Midwives' practices related to cervical cancer screening during pregnancy: A vignette-based study. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 26:100539. [PMID: 32623314 DOI: 10.1016/j.srhc.2020.100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe midwives' practices related to cervical cancer screening and women's eligibility for screening during pregnancy. STUDY DESIGN Cross-sectional vignette-based study of French midwives during February-May 2018. MAIN OUTCOME MEASURES Participants were asked to complete an internet-based questionnaire: a clinical case-vignette about a woman eligible for cervical cancer screening during pregnancy and a short self-administered questionnaire. RESULTS We obtained 273 complete questionnaires from eligible midwives. Of those responding, 15% reported that they never screened for cervical cancer during pregnancy, 63.7% did so for women 25 years or older, and 51% adhered to the recommended intervals between tests. Overall, 110 (40%) midwives adhered to the complete screening protocol (age at initiation and interval). In this clinical case vignette of a woman meeting the criteria for screening, only 29% of midwives reported they would perform a Pap test at 25 weeks of gestation, while 91% would at 10 weeks. CONCLUSION Midwives' practices of cervical cancer screening and their determination of women's eligibility during pregnancy vary, especially according to gestational age; Nevertheless, pregnancy is an appropriate time to screen women who meet the criteria for cervical cancer screening, especially if they are not receiving regular gynaecological care.
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Affiliation(s)
- Léa Kervella
- Midwifery Department, Versailles Saint Quentin University, Montigny-le-Bretonneux, France
| | - Paul Berveiller
- Department of Obstetrics and Gynecology, Poissy-Saint-Germain en Laye Hospital, Poissy, France; EA7404 GIG, UFR S. Veil-Santé, Versailles Saint Quentin University, Montigny-le-Bretonneux, France
| | - Marie Bourdillon
- Midwifery Department, Versailles Saint Quentin University, Montigny-le-Bretonneux, France
| | - Anne Rousseau
- Midwifery Department, Versailles Saint Quentin University, Montigny-le-Bretonneux, France; Department of Obstetrics and Gynecology, Poissy-Saint-Germain en Laye Hospital, Poissy, France; EA 7285 RISCQ, UFR S. Veil-Santé, Versailles Saint Quentin University, Montigny-le-Bretonneux, France.
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Morris CP, Chowsilpa S, Mustafa S, Chan I, Miller D, Maleki Z, Rodriguez EF. Impact of the Current US Preventive Services Task Force Recommendations for Cervical Cancer Screening in Young Women 21 to 29 Years Old. Am J Clin Pathol 2020; 153:734-742. [PMID: 32221518 DOI: 10.1093/ajcp/aqaa012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In 2012, the US Preventive Services Task Force decreased the recommended frequency of cervical cytology screening to once every 3 years and recommended against testing women younger than 21 years regardless of sexual history. We evaluated the impact of this in 21 to 29-year-old women at a tertiary care academic medical center in 2011 and 2017. METHODS We retrospectively analyzed Papanicolaou test results at two time points in 21- to 29-year-old women. RESULTS There was a decrease in the number of high-grade lesions in 21- to 25-year-old women (odds ratio [OR], 0.36) from 2011 to 2017. Within the 26- to 29-year-old patient group, there was a trend toward a higher percentage of high-grade squamous intraepithelial lesion (HSIL) in 2017 compared to 2011 on cytology, which did not reach statistical significance (OR, 1.46). However, follow-up histologic specimens showed a higher percentage of HSIL in 2017 compared to 2011 in this age group (OR, 2.16). CONCLUSIONS Our findings suggest that the cervical cancer screening guidelines introduced in 2012 have not had a detrimental impact on the outcomes of cervical cancer screening for 21- to 25-year-old women. However, we need to continue monitoring the effects of decreased screening in 26- to 29-year-old women.
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Affiliation(s)
- C Paul Morris
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
- National Institute of Allergy and Infectious Disease, Bethesda, MD
| | - Sayanan Chowsilpa
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sara Mustafa
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
| | - Isaac Chan
- Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD
| | - Daniel Miller
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
| | - Zahra Maleki
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
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Exacerbating disparities?: Cervical cancer screening and HPV vaccination. Prev Med 2020; 130:105902. [PMID: 31730943 DOI: 10.1016/j.ypmed.2019.105902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/29/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
The human papillomavirus (HPV) vaccine is a powerful tool in cancer prevention. In combination with cervical cancer screening programs, this vaccine has the potential to nearly eliminate death from cervical cancer. However, this remarkable public health success can only be realized if vaccines reach those most at risk-unscreened women. Vaccinating only those already well-screened would have little impact on cervical cancer mortality, exacerbate disparities, and be a striking public health failure. We use data from the Behavioral Risk Factor Surveillance System optional Adult HPV Vaccination module between 2013 and 2016 to assess the association between HPV vaccine status and cervical cancer screening behavior. Only 27% of eligible women had received any HPV vaccination. Uninsured women were less likely to be vaccinated (aOR: 0.48, 95% CI:0.30-0.76) and less likely to be screened (aOR: 0.41, 95% CI:0.28-0.60) than insured women. Vaccinated women were more than twice as likely to be up to date on screening than unvaccinated women (aOR: 2.14, 95% CI:1.46-3.12). Younger women were 49% less likely to be up to date on screening (aOR: 0.51, 95% CI:0.37-0.71), but over 4 times more likely to be vaccinated (aOR: 4.44, 95% CI:3.20-6.17) than older women. Unvaccinated, unscreened women are at continued risk for cervical cancer. Uninsured women were most likely to be in this group. Concerted efforts should be focused on increasing vaccination and screening in this population. Cancer prevention innovations, like the HPV vaccine, must reach at-risk populations to avoid further protecting the protected and failing to reduce existing health disparities.
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Murfin J, Irvine F, Meechan-Rogers R, Swift A. Education, income and occupation and their influence on the uptake of cervical cancer prevention strategies: A systematic review. J Clin Nurs 2019; 29:393-415. [PMID: 31713934 DOI: 10.1111/jocn.15094] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 09/11/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
Abstract
AIMS To report a systematic review of the literature exploring how education, income and occupation influence the uptake of cervical screening and HPV vaccination among eligible women in developed countries, including the United Kingdom, United States, Spain, Germany and Norway. BACKGROUND Cervical cancer remains a highly prevalent disease despite it being largely preventable through cervical screening and HPV vaccination. Incidence and mortality of cervical cancer are unequally distributed among socioeconomic groups, warranting research into how individual socioeconomic factors contribute to this unbalanced uptake of prevention strategies. DESIGN Systematic review and narrative synthesis. METHODS The PRISMA guidelines (PLoS Medicine, 6, 2009, e1000097) guided the selection of papers. MEDLINE, CINHAL, PsychINFO, Science Citation Index and HMIC were searched. Ten articles were suitable. Key findings were then extracted, and a narrative synthesis was completed, using suitable guidance and the AXIS tool. RESULTS Obtaining high school or college education is associated with uptake of both cervical screening and HPV vaccination. Total household income and income in respect of the countries' poverty line was measured less frequently than education, but associated with screening and vaccination in some studies. Occupation was infrequently measured in comparison to education and income, limiting conclusions of its association to uptake. CONCLUSION Education and income have an association with uptake of cervical screening and HPV vaccination among women. However, evidence is insufficient to affirm a relationship between occupation and uptake of screening and vaccination. Further research would be advised to strengthen these findings. RELEVANCE TO CLINICAL PRACTICE Interventions to promote cervical cancer prevention strategies should be targeted at women and girls with lower education levels and lower income. However, differences are displayed in the relationships between the individual socioeconomic factors and uptake of preventative strategies between countries and populations and so they should be considered separately. Nurses play a considerable role in people's perceptions and experiences of cervical screening and HPV vaccination. The review findings offer new insight that can inform future policy and nursing practice on targeting interventions to promote uptake among women who are underusing cervical cancer prevention programmes.
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Affiliation(s)
- Jessica Murfin
- School of Nursing, University of Birmingham, Birmingham, UK
| | - Fiona Irvine
- School of Nursing, University of Birmingham, Birmingham, UK
| | | | - Amelia Swift
- School of Nursing, University of Birmingham, Birmingham, UK
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