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Novais IR, Coelho CO, Machado HC, Surita F, Zeferino LC, Vale DB. Cervical cancer screening in Brazilian Amazon Indigenous women: Towards the intensification of public policies for prevention. PLoS One 2023; 18:e0294956. [PMID: 38064494 PMCID: PMC10707695 DOI: 10.1371/journal.pone.0294956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Indigenous women are vulnerable to cervical cancer. Screening is a strategy to reduce the burden of the disease. OBJECTIVE To evaluate the prevalence profile of cervical cancer screening cytological results in Brazilian indigenous women by age and frequency of tests compared to non-indigenous women. METHODS A cross-sectional study evaluating the prevalences of screening test results in indigenous women assisted in the Brazilian Amazon from 2007 to 2019 (3,231 tests), compared to non-indigenous women (698,415 tests). The main outcome was the cytological result. Other variables were frequency, age groups, and population. The frequency was categorized as "1st test", the first test performed by the women in their lifetime, or "screening test," tests from women who had previously participated in screening. Analyzes were based on prevalences by age group and population. We used Prevalence Ratios (PR) and 95% Confidence Intervals for risks and linear regression for trends. RESULTS Data from the 1st test showed a higher prevalence of Low-grade Squamous Intraepithelial Lesion (LSIL) in indigenous women. Peaks were observed in indigenous under 25, 35 to 39, 45 to 49, and 60 to 64. The prevalence of High-grade Squamous Intraepithelial Lesion or more severe (HSIL+) was low in both groups in women younger than 25. The indigenous HSIL+ prevalence curve showed a rapid increase, reaching peaks in women from 25 to 34 years, following a slight decrease and a plateau. In screening tests, HSIL+ was more prevalent in indigenous from 25 to 39 (PR 4.0,2.3;6.8) and 40 to 64 (PR 3.8,1.6;9.0). In indigenous, the PR of HSIL+ results in screening tests over 1st tests showed no screening effect in all age groups. In non-indigenous, there was a significant effect toward protection in the age groups over 25. CONCLUSION This screening study of indigenous women from diverse ethnicities showed a higher prevalence of cytological LSIL and HSIl+ than in non-indigenous women. The protective screening effect in reducing HSIL+ prevalence was not observed in indigenous.
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Affiliation(s)
- Iria Ribeiro Novais
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Camila Olegario Coelho
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Helymar Costa Machado
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Fernanda Surita
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Luiz Carlos Zeferino
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Diama Bhadra Vale
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
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Kultalahti H, Heinävaara S, Sarkeala T, Pankakoski M. Effect of Test History at Ages 50-64 on Later Cervical Cancer Risk: A Population-based Case-control Study. CANCER RESEARCH COMMUNICATIONS 2023; 3:1823-1829. [PMID: 37700796 PMCID: PMC10494786 DOI: 10.1158/2767-9764.crc-23-0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/26/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
As life expectancy increases, the effectiveness of cervical cancer screening programs needs to be reassessed for the older population. We addressed the effect of test history in and outside organized screening at age 50-64 years on later cervical cancer risk. A case-control study was conducted by deriving 229 cases of 65-79 years old women with invasive cervical cancer in 2010-2019 from the Finnish Cancer Registry. Ten controls were matched for each case by birth year and hospital district. The effect of test uptake and abnormal results in 50-64 year olds on cancer risk was investigated using conditional logistic regression and adjusted for self-selection. Test uptake within the 50-64 years age group showed 75% lower odds of cervical cancer [adjusted OR (aOR) = 0.25; 95% confidence interval (95% CI), 0.18-0.35]. Untested women had 4.9 times higher odds than those tested with normal results (aOR = 4.86; 95% CI, 3.42-6.92). Having at least one abnormal test result increased the odds by 2.5 when compared with only normal results but showed lower odds when compared with untested women. The importance of testing is exhibited by the result showing a reduction of odds of cancer to one-fourth for those tested compared with untested. Similarly, receiving abnormal results was protective of cancer compared with having no tests highlighting the importance of proper follow-up. Therefore, screening history should be considered when further developing cervical cancer screening programs with special interest in non-attenders and those receiving abnormal results at older ages. Significance To our knowledge, this is the first study from Finnish data describing the effect of test history on later cervical cancer at older ages. Focusing on the cervical tests taken within the Finnish national screening program and outside it highlights the overall importance of having cervical tests and adds this study into the slowly increasing number of studies considering all cervical testing in Finland.
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Affiliation(s)
- Henric Kultalahti
- Finnish Cancer Registry, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sirpa Heinävaara
- Finnish Cancer Registry, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Maiju Pankakoski
- Finnish Cancer Registry, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Zhu B, Yu H, Ni P, Chen X, Zhang J, Wang D. A population-based cross-sectional study on the situation of cervical cancer screening in Liaoning, China. BMC Womens Health 2023; 23:144. [PMID: 36991455 PMCID: PMC10061794 DOI: 10.1186/s12905-023-02249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Cervical cancer (CC) screening is currently recognized as an effective intervention for CC. Previous studies found that the proportion of screening was low in China, especially in Liaoning. Therefore, we performed a population-based cross-sectional survey to investigate the situation of cervical cancer screening and analyze their related factors for providing a decision-making basis for sustainable and effective development of cervical cancer screening.
Methods
This population-based cross-sectional study involved aged 30 to 69 years in nine counties/districts in Liaoning from 2018 to 2019. Data were collected using the quantitative data collection methods, and analyzed in SPSS version 22.0.
Results
Overall, only 22.37% of 5334 respondents reported having ever been screened for cervical cancer in past 3 years, and 38.41% of respondents reported having the willingness for cervical cancer screening in next 3 years. In the rate of CC screening, multilevel analysis indicated that age, marital status, education level, type of occupation, medical insurance, family income, place of residence and regional economic level had a significant impact on proportion of screening. In the rate of CC screening willingness, multilevel analysis indicated that age, family income, health status, place of residence, regional economic level and CC screening still had a significant impact, but marital status, education level and medical insurance type had no significant impact. There was no significant difference in marital status, education level and medical insurance type after the factors of CC screening were added in the model.
Conclusion
Our study found both proportion of screening and willingness were at a low level, and age, economic and regional factors were the main factors for implementation of CC screening in China. In the future, targeted policies should be formulated according to the characteristics of different groups of people, and reduce the gap in the current health service capacity between different regions.
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Voidăzan TS, Uzun CC, Kovacs Z, Rosznayai FF, Turdean SG, Budianu MA. The Hybrid Capture 2 Results in Correlation with the Pap Test, Sexual Behavior, and Characteristics of Romanian Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3839. [PMID: 36900850 PMCID: PMC10001103 DOI: 10.3390/ijerph20053839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) infection is the major cause of cervical cancer (CC); hence, it is critical to understand the processes by which HPV infection causes squamous intraepithelial lesions, as well as the proper diagnostic tools. The objective of this study was to establish the correlations between Pap test results and Hybrid Capture 2 (HC2) tests findings. MATERIALS AND METHODS This study included 169 women between the ages of 30 and 64, who presented for consultation in gynecological clinics in both the public and the private sectors. These women reported symptoms, such as abnormal vaginal discharge and genital irritation, as well as early onset of sexual activity, multiple sexual partners, history of other sexually transmitted infections or high-risk sexual partners, immunosuppression, or tobacco smoking. Pap tests and HPV testing, using the HC2 method, were performed for the women enrolled in the study, including data gathered after patients completed questionnaires concerning their sexual behavior. RESULTS The HC2 method revealed that 66 patients (39.1%) tested positive for high-risk HPV types. Of the patients with positive results, 14 (21.2%) presented Atypical Squamous Cells of Undetermined Significance (ASC-US) compared to 10 (9.7%) patients in the negative group (p = 0.042). Atypical Squamous Cells for which a high-grade lesion cannot be excluded (ASC-H) were identified primarily in women with positive HC2 (6.1%). HR-HPV positivity was substantially more associated with low-grade ASC-US or low-grade squamous intraepithelial lesion (LSIL) and high-grade ASC-H cytology (OR = 2.53; 95% CI: 1.10-5.80, respectively, OR = 14.9; 95%CI: 1.006-34.59). Unmarried women (31.8%; p = 0.004) and women with multiple partners (over four partners, 10.6%; p = 0.03) were more likely to have an HPV infection when compared to married women and those with fewer sexual partners. CONCLUSIONS Understanding the epidemiology of HPV genital infections is essential for developing preventive measures against this infection and CC. Identifying the most prevalent HPV types, and determining the incidence of HPV oncogenic infections, in conjunction with Pap test results and sexual behavior information, can constitute part of an algorithm for the efficient management of cervical intraepithelial lesions.
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Affiliation(s)
- Toader Septimiu Voidăzan
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Cosmina Cristina Uzun
- Department of Biochemistry, Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Zsolt Kovacs
- Department of Biochemistry, Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Florin Francisc Rosznayai
- Department of Obstetrics Gynecology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Sabin Gligore Turdean
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Mihaela-Alexandra Budianu
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
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van den Helder R, Steenbergen RDM, van Splunter AP, Mom CH, Tjiong MY, Martin I, Rosier-van Dunné FMF, van der Avoort IAM, Bleeker MCG, van Trommel NE. HPV AND DNA METHYLATION TESTING IN URINE FOR CERVICAL INTRAEPITHELIAL NEOPLASIA AND CERVICAL CANCER DETECTION. Clin Cancer Res 2022; 28:2061-2068. [PMID: 35266975 DOI: 10.1158/1078-0432.ccr-21-3710] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/28/2021] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Biomarker detection in urine offers a potential solution to increase effectiveness of cervical cancer screening programs by attracting non-responders. In this prospective study, the presence of high-risk human papillomavirus (hrHPV DNA) and the performance of DNA methylation analysis was determined for the detection of cervical cancer and high-grade cervical intraepithelial neoplasia (CIN2/3) in urine, and compared to paired cervicovaginal self-samples and clinician-taken cervical scrapes. METHODS A total of 587 samples were included from 113 women with cervical cancer, 92 women with CIN2/3, and 64 controls. Samples were tested for hrHPV DNA and five methylation markers. Univariate and multivariate logistic regression and leave-one-out cross-validation were used to determine the methylation marker performance for CIN3 and cervical cancer (CIN3+) detection in urine. Agreement between samples was determined using Cohen's kappa statistics and the Spearman correlation coefficients. RESULTS HrHPV presence was high in all sample types, 79% to 92%. Methylation levels of all markers in urine significantly increased with increasing severity of disease. The optimal marker panel (ASCL1/LHX8) resulted in an AUC of 0.84 for CIN3+ detection in urine, corresponding to an 86% sensitivity at a 70% predefined specificity. At this threshold 96%(109/113) of cervical cancers, 68%(46/64) of CIN3 and 58%(14/24) of CIN2 were detected. Between paired samples, a strong agreement for HPV16/18 genotyping and a fair to strong correlation for methylation was found. CONCLUSION HrHPV DNA and DNA methylation testing in urine offers a promising solution to detect cervical cancer and CIN2/3 lesions, especially for women currently unreached by conventional screening methods.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nienke E van Trommel
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
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O'Donovan B, Mooney T, Rimmer B, Fitzpatrick P, Flannelly G, Doherty L, Martin C, O'Leary J, O'Connor M, Sharp L. Advancing understanding of influences on cervical screening (non)-participation among younger and older women: A qualitative study using the theoretical domains framework and the COM-B model. Health Expect 2021; 24:2023-2035. [PMID: 34476875 PMCID: PMC8628586 DOI: 10.1111/hex.13346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Effective screening can prevent cervical cancer, but many women choose not to attend their screening tests. OBJECTIVE This study aimed to investigate behavioural influences on cervical screening participation using the Theoretical Domains Framework (TDF) and COM-B models of behaviour change. DESIGN A qualitative study and semistructured phone interviews were conducted with women invited for routine screening tests within the national cervical screening programme in Ireland. SETTING AND PARTICIPANTS Forty-eight women aged 25-65 years were recruited from the national screening register. RESULTS Seven core themes were identified that mapped to three COM-B components and 11 TDF domains: (1) knowledge of cervical cancer and screening, (2) coping with smear tests, (3) competing motivational processes-automatic and reflective, (4) cognitive resources, (5) role of social support, (6) environmental influences and (7) perceputal and practical influences. A range of knowledge about screening, perceived risk of cervical cancer and human papillomavirus infection was evident. Factors that influenced screening behaviours may be hierarchical-some were assigned greater importance than others. Positive screening behaviours were linked to autonomous motivation. Deficits in physical and psychological capability (inadequate coping skills) were barriers to screening, while physical and social opportunity (e.g. healthcare professional 'champions') could facilitate participation. Older women raised age-related issues (e.g. screening no longer necessary) and had more negative attitudes to screening, while younger women identified practical barriers. CONCLUSIONS This study provides insight into screening participation and will aid development of theoretically informed interventions to increase uptake. PATIENT OR PUBLIC CONTRIBUTION Women invited for screening tests through the national screening programme were interviewed. A Public & Patient Involvement (PPI) Panel, established to provide input into all CERVIVA research projects, advised the research team on recruitment materials and were given the opportunity to review and comment on the interview topic guide. This panel is made up of six women with various cervical screening histories and experiences.
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Affiliation(s)
| | - Therese Mooney
- Programme Evaluation Unit, National Screening Service, Dublin, Ireland
| | - Ben Rimmer
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Patricia Fitzpatrick
- Programme Evaluation Unit, National Screening Service, Dublin, Ireland.,School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | | | | | - Cara Martin
- Department of Histopathology, Trinity College, University of Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - John O'Leary
- Department of Histopathology, Trinity College, University of Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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Barchuk AA, Raskina YV, Smirnova OV, Belyaev AM, Bagnenko SF. Cancer screening at the level of state programs: review, recommendations and management. Public Health 2021. [DOI: 10.21045/2782-1676-2021-1-1-19-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An overview of existing cancer screening programs, their organization system, and the main implementation parameters is presented. The methods of primary screening that have been shown to be effective in reducing mortality from certain cancers, as well as the reasons for the lack of screening programs in relation to some of them, are listed. The existing screening programs and their main characteristics are considered, and examples of using economic analysis to change screening programs are given. It is noted that in countries even with a large coverage, for example, in the United States and Germany, there is no single national register of screening, and the invitation system does not have a population-based nature. Although the large coverage and development of health systems in these countries allows for the positive effects of opportunistic screening, its effectiveness is lower than in countries with organized programs, and the costs are higher.
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Keltto N, Leivonen A, Pankakoski M, Sarkeala T, Heinävaara S, Anttila A. Cervical testing beyond the screening target age - A register-based cohort study from Finland. Gynecol Oncol 2021; 162:315-321. [PMID: 34074539 DOI: 10.1016/j.ygyno.2021.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE It has been proposed that cervical cancer screening should be continued in women with previous abnormal results or irregular attendance. We examined the coverage and factors that might influence cervical testing beyond the age range of the organized cervical screening programme in Finland. The national programme invites women in every five years least until the age of 60. After the stopping age, only opportunistic service is available. METHODS Data on cervical testing were collected from the Mass Screening Registry and providers of opportunistic Pap/HPV-testing and were linked with information on socio-economic variables. The study included 373,353 women who had at least one invitation to the national screening programme between ages 50-60 years, and who were aged 65-74 years in the follow-up period 2006-2016. Multivariable binomial regression models were conducted to determine associations. RESULTS Altogether 33% of the study population had been tested at least once at ages 65-74 years. Previous regular screening attendance (adjRR 1.70; 95% CI 1.67-1.73) and earlier abnormal results (adjRR 2.08; 95% CI 2.04-2.12) were most clearly related to higher testing adherence at older age. Other factors related to higher testing adherence were urban area of residence, domestic mother tongue, high education level, and high socio-economic status. CONCLUSION Testing at older age was frequent with normal results, whereas only a small proportion of women with earlier abnormal results or irregular attendance were tested. The upper age limit of the national programme should be raised to 65 years, and the invitations thereafter should be targeted to selected high-risk groups.
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Affiliation(s)
- Natalie Keltto
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland.
| | - Aku Leivonen
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Maiju Pankakoski
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Tytti Sarkeala
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Sirpa Heinävaara
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
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Raiah M, Ahmed Fouatih Z. [Time trends and age-period-cohort effects on the incidence of the most frequent cancers in Oran, Algeria, 1999-2018]. Rev Epidemiol Sante Publique 2021; 69:154-159. [PMID: 33583656 DOI: 10.1016/j.respe.2021.01.004] [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: 06/26/2020] [Revised: 11/30/2020] [Accepted: 01/04/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer is currently one of the major public health problems in Algeria. The aim of this study was to examine time trends and the effects of age, period and cohort on incidence at the major cancer locations from 1999 to 2018 in Oran, Algeria. METHODS Data on the five most frequent primary cancer locations among patients aged 20-79 years were collected from the Oran cancer registry. Annual percentile changes in incidence rates were evaluated using the Joinpoint regression program. Age-period-cohort models were designed to examine the effects of age, period and birth cohort on cancer incidence. RESULTS From 1999 to 2018, there were 12,278 incident cases at the five major cancer locations. Unfavorable trends in incidence were observed regarding lung and colorectal cancers in both sexes, as well as breast cancer in women. Age-period-cohort analysis showed that age, period and birth cohort yielded different effects at different cancer locations. CONCLUSION The observed trends primarily reflect lifestyle changes in Algeria over the course of recent years.
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Affiliation(s)
- M Raiah
- Epidemiology and preventive medicine unit, University hospital of Oran, Oran, Algérie.
| | - Z Ahmed Fouatih
- Epidemiology and preventive medicine unit, University hospital of Oran, Oran, Algérie
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Kassie AM, Abate BB, Kassaw MW, Aragie TG, Geleta BA, Shiferaw WS. Impact of knowledge and attitude on the utilization rate of cervical cancer screening tests among Ethiopian women: A systematic review and meta-analysis. PLoS One 2020; 15:e0239927. [PMID: 33290426 PMCID: PMC7723289 DOI: 10.1371/journal.pone.0239927] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Cervical cancer is a major public health problem, particularly in resource-limited settings. The use of vaccination and screening tests has reduced the burden of cervical cancer in developed countries. However, the situation is quite the reverse in developing countries, including Ethiopia. Hence, this study aimed to estimate the pooled impact of knowledge and attitude on the prevalence of cervical cancer screening service utilization rates among Ethiopian women. METHODS Studies that examined cervical cancer screening service utilization among women in Ethiopia were searched from five international databases. Cochran's Q chi-square and the I-squared test statistics were used to check the presence of heterogeneity among the included studies. The funnel plot and Egger's regression tests were also used to assess the presence of publication bias. A weighted DerSimonian and Laird random-effects model was employed. Subgroup analysis was performed by the study population concerning the prevalence of cervical cancer screening service utilization rates. Sensitivity analysis was also conducted to assess the effect of a single study on the pooled estimates. Data analysis was performed using STATA™ Version 14 software. RESULTS A total of 44 studies with 28,186 study participants were included. The estimated pooled prevalence of cervical cancer screening service utilization was 8.11% (95% CI: 7.26, 8.97). After adjustment for publication bias with the trim and fill analysis, the estimated prevalence rate appeared to be 5.47% (95% CI: 4.66, 6.28). The prevalence of cervical cancer screening service utilization was higher among HIV-positive women, 16.85%, and in studies conducted among health care workers, 10.24%, than the general population. The pooled effect of knowledge on the utilization of cervical cancer screening tests among Ethiopian women was statistically significant (AOR = 3.20, 95% CI: 1.63, 6.31). Similarly, the pooled estimated odds of utilizing cervical cancer screening tests were 6.1 times higher (AOR = 6.09, 95% CI: 1.09, 34.36) among women who had a favorable attitude towards the screening tests. CONCLUSION Knowledge and attitude had a significant impact on the prevalence of cervical cancer screening test utilization rates among women in Ethiopia. However, the prevalence of cervical cancer screening service utilization among Ethiopian women is very low. Hence, large-scale awareness programs and situation-based strategies need to be designed to increase the uptake of cervical cancer screening services in the country.
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Affiliation(s)
- Ayelign Mengesha Kassie
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Mesfin Wudu Kassaw
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Teshome Gebremeskel Aragie
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Bonsa Amsalu Geleta
- Department of Nursing, College of Health Sciences, Metu University, Metu, Oromia Regional State, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Amhara Regional State, Ethiopia
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Tranberg M, Petersen LK, Elfström KM, Hammer A, Blaakær J, Bennetsen MH, Jensen JS, Andersen B. Expanding the upper age limit for cervical cancer screening: a protocol for a nationwide non-randomised intervention study. BMJ Open 2020; 10:e039636. [PMID: 33154056 PMCID: PMC7646343 DOI: 10.1136/bmjopen-2020-039636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Cervical cancer screening ceases between the ages of 60 and 65 in most countries. Yet, a relatively high proportion of cervical cancers are diagnosed in women above the screening age. This study will evaluate if screening of women aged 65-69 years may result in increased detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared with women not invited to screening. Invited women may choose between general practitioner (GP)-based screening or cervico-vaginal self-sampling. Furthermore, the study will assess if self-sampling is superior to GP-based screening in reaching long-term unscreened women. METHODS AND ANALYSIS This population-based non-randomised intervention study will include 10 000 women aged 65-69 years, with no record of a cervical cytology sample or screening invitation in the 5 years before inclusion. Women who have opted-out of the screening programme or have a record of hysterectomy or cervical amputation are excluded. Women residing in the Central Denmark Region (CDR) are allocated to the intervention group, while women residing in the remaining four Danish regions are allocated to the reference group. The intervention group is invited for human papillomavirus-based screening by attending routine screening at the GP or by requesting a self-sampling kit. The reference group receives standard care which is the opportunity to have a cervical cytology sample obtained at the GP or by a gynaecologist. The study started in April 2019 and will run over the next 4.5 years. The primary outcome will be the proportion of CIN2+ detected in the intervention and reference groups. In the intervention group, the proportion of long-term unscreened women attending GP-based screening or self-sampling will be compared. ETHICS AND DISSEMINATION The study has been submitted to the Ethical Committee in the CDR which deemed that the study was not notifiable to the Committee and informed consent is therefore not required. The study is approved by the Danish Data Protection Regulation and the Danish Patient Safety Authority. Results will be disseminated in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04114968.
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Affiliation(s)
- Mette Tranberg
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Lone Kjeld Petersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- OPEN, Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Klara Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Center of Stockholm-Gotland, Stockholm, Sweden
| | - Anne Hammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Regionshospitalet Herning, Herning, Denmark
| | - Jan Blaakær
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- OPEN, Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Jørgen Skov Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Ma Y, Di J, Bi H, Zhao Q, Qin T, Xu W, Liu Z, Yi N, Zhao J, Zhou D, Chen J, Yang Q. Comparison of the detection rate of cervical lesion with TruScreen, LBC test and HPV test: A Real-world study based on population screening of cervical cancer in rural areas of China. PLoS One 2020; 15:e0233986. [PMID: 32634143 PMCID: PMC7340311 DOI: 10.1371/journal.pone.0233986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/16/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE China carries a heavy burden of cervical cancer and has an alarmingly low cervical cancer screening rate. In order to achieve the goal of cervical cancer elimination, there is an urgent need for suitable methods and strategies in China. MATERIALS AND METHODS A total 9972 woman who received cervical cancer screening services of National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in 8 project counties participated in this study. TruScreen, HPV test and LBC test were performed in all participants. A total of 1945women had one or more than one positive or abnormal screening results of the above three screening tests subsequently received colposcopy. The detection rate of CIN2+ between the three tests were compared. RESULTS No matter what kind of screening method is used, the CIN2+ detection rate in the eastern regions was much higher than that in the central and western regions. The total detection rate of CIN2+ in HPV group was highest (0.73%), following in LBC group (0.44%) and TS group (0.31%). There was statistically significant difference in the total detection rate of CIN2+ between TS and HPV groups, LBC and HPV groups, respectively. There was no statistical difference in the total detection rate of CIN2+ between TS and LBC screening groups. Moreover, except for the eastern regions, there was no statistical difference in the detection rate of CIN2+ between TS group and the other two groups in central and western regions. CONCLUSION If it can meet the requirements of the laboratory and personnel, HPV test seems to be the preferred method for cervical cancer screening in rural areas of China. The characteristics of minimal training requirements, simple operation, real-time results obtained without the collection of cervical cell samples and the help of laboratory equipment and cytologists of TS make it ideal for cervical cancer screening in low-resource regions.
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Affiliation(s)
- Yu Ma
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangli Di
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Bi
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Qingping Zhao
- Department of Gynecology, Sichuan Provincial Hospital for Women and Children, Chengdu, China
| | - Tianhua Qin
- Department of Gynecological Clinic, Xinjiang Uygur Autonomous Region Maternal and Child Health Hospital, Ürümqi, China
| | - Wen Xu
- Women’s Health Care Department, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Zhaoyang Liu
- Department of Gynecology, Northwest Women’s and Children’s Hospital (Shaanxi Maternal and Child Health Hospital), Xi’an, China
| | - Nianhua Yi
- Department of Women’s Health Care, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Jing Zhao
- Department of Gynecology, Hunan Provincial Maternal and Child Health Hospital, Changsha, China
| | - Deping Zhou
- Cervical Disease Treatment Center, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jiancui Chen
- Cervical Disease Diagnosis and Treatment Health Center, Fujian Provincial Maternity and Children’s Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qi Yang
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
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13
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Zamorano-Leon JJ, López-de-Andres A, Álvarez-González A, Astasio-Arbiza P, López-Farré AJ, de-Miguel-Diez J, Jiménez-García R. Reduction from 2011 to 2017 in adherence to breast cancer screening and non-improvement in the uptake of cervical cancer screening among women living in Spain. Maturitas 2020; 135:27-33. [DOI: 10.1016/j.maturitas.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/23/2019] [Accepted: 02/23/2020] [Indexed: 12/24/2022]
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14
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Bielska-Lasota M, Rossi S, Krzyżak M, Haelens A, Domenic A, De Angelis R, Maciejczyk A, Rodríguez-Barranco M, Zadnik V, Minicozzi P. Reasons for low cervical cancer survival in new accession European Union countries: a EUROCARE-5 study. Arch Gynecol Obstet 2019; 301:591-602. [PMID: 31853712 DOI: 10.1007/s00404-019-05412-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE With better access to early diagnosis and appropriate treatment, cervical cancer (CC) burden decreased in several European countries. In Eastern European (EE) countries, which accessed European Union in 2004, CC survival was worse than in the rest of Europe. The present study investigates CC survival differences across five European regions, considering stage at diagnosis (local, regional and metastatic), morphology (mainly squamous versus glandular tumours) and patients' age. METHODS We analysed 101,714 CC women diagnosed in 2000-2007 and followed-up to December 2008. Age-standardised 5-year relative survival (RS) and the excess risks of cancer death in the 5 years after diagnosis were computed. RESULTS EE women were older and less commonly diagnosed with glandular tumours. Proportions of local stage cancers were similar across Europe, while morphology- and stage-specific RS (especially for non-metastatic disease) were lower in Eastern Europe. Adjusting for age and morphology, excess risk of local stage CC death for EE patients remained higher than that for other European women. CONCLUSION Stage, age and morphology alone do not explain worse survival in Eastern Europe: less effective care may play a role, probably partly due to fewer or inadequate resources being allocated to health care in this area, compared to the rest of Europe.
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Affiliation(s)
- Magdalena Bielska-Lasota
- Department of Health Promotion and Chronic Diseases Prevention, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | - Michalina Krzyżak
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, Bialystok, Poland
| | - Annemie Haelens
- Research Department, Belgian Cancer Registry, Brussels, Belgium
| | | | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | | | - Miguel Rodríguez-Barranco
- Andalusian School of Public Health, Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain.,Centro de Investigación Biomédica en Red de Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain
| | - Vesna Zadnik
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. .,Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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15
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Mauro M, Rotundo G, Giancotti M. Effect of financial incentives on breast, cervical and colorectal cancer screening delivery rates: Results from a systematic literature review. Health Policy 2019; 123:1210-1220. [PMID: 31587819 DOI: 10.1016/j.healthpol.2019.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 01/23/2023]
Abstract
Preventive care, such as screening, is important for reducing the risk of cancer, a leading cause of death worldwide. Indeed, some type of cancers are detected through screening programs, which in most countries run for colorectal, breast, and cervical cancers. In this context, general practitioners play a key role in increasing the participation rate in cancer screening programs. To improve cancer screening delivery rates, performance incentives have increasingly been implemented in primary care by healthcare payers and organizations in different countries. The effects of these tools are still not clear. We conducted a systematic literature review in order to answer the following research question: What is the evidence in the literature for the effects of financial incentives on the delivery rates of breast, cervical and colorectal cancer screening in general practice? We performed a literature search in Web of Science, PubMed, Cochrane Library and Google Scholar, according to the PRISMA guidelines. 18 studies were selected, classified and discussed according to the health preventive services investigated. Most of studies showed partial or no effects of financial incentives on breast and cervical cancer screening delivery rates. Few positive or partial effects were found regarding colorectal cancer screening. Ongoing monitoring of incentive programs is critical to determining the effectiveness of financial incentives and their effects on the improvement of cancer screening delivery rates.
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Affiliation(s)
- Marianna Mauro
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy.
| | - Giorgia Rotundo
- Department of Legal, Historical, Economic and Social Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Monica Giancotti
- Department of Clinical and Experimental Medicine, Magna Graecia University, Viale Europa, Catanzaro, Italy.
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16
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Mignot S, Ringa V, Vigoureux S, Zins M, Panjo H, Saulnier PJ, Fritel X. Pap tests for cervical cancer screening test and contraception: analysis of data from the CONSTANCES cohort study. BMC Cancer 2019; 19:317. [PMID: 30952209 PMCID: PMC6451274 DOI: 10.1186/s12885-019-5477-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/14/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In France, a Pap test for cervical cancer screening is recommended every three years for all sexually active women aged 25 to 65 years. Modes of contraception (any or no contraception, with or without a visit to a physician, and with or without a gynecological examination) may influence adhesion to screening: women who use intrauterine device (IUD) should be more up to date with their cervical cancer screening more often than those using other means of contraception. Our objectives were to analyze the association between modes of contraception and Pap tests for screening. METHODS This cross sectional study is based on the CONSTANCES cohort enabled us to include 16,764 women aged 25-50 years. The factors associated with adhesion to cervical cancer screening (defined by a report of a Pap test within the previous 3 years) was modeled by logistic regression. Missing data were imputed by using multiple imputations. The multivariate analyses were adjusted for sex life, social and demographic characteristics, and health status. RESULTS Overall, 11.2% (1875) of the women reported that they were overdue for Pap test screening. In the multivariate analysis there was no significant difference between women using an IUD and those pills or implant of pap test overdue ORa:0.9 CI95% [0.8-1.1], ORa 1.3 CI95% [0.7-2.7] respectively. Women not using contraceptives and those using non-medical contraceptives (condoms, spermicides, etc.) were overdue more often ORa: 2.6 CI95% [2.2-3.0] and ORa: 1.8 CI95% [1.6-2.1] respectively than those using an IUD. CONCLUSION Women seeing medical professionals for contraception are more likely to have Pap tests.
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Affiliation(s)
- Stéphanie Mignot
- Department of General Practice, University of Poitiers, France: 3 rue de la Milétrie, 86000 Poitiers, France
| | - Virginie Ringa
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
| | - Solène Vigoureux
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
- Ined, Paris, France
- Obstetrics & Gynecology Department, Hôpital Bicêtre, GHU Sud, AP-HP, Faculty of Medicine, University of Paris Sud, F-94276 Le Kremlin Bicêtre, France
| | - Marie Zins
- Epidemiological Population-Based Cohorts Unit, INSERM UMS 11, Villejuif, France
- University of Paris-Descartes, Paris, France
| | - Henri Panjo
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
- Ined, Paris, France
| | - Pierre-Jean Saulnier
- Clinical Research Centree CIC1402, INSERM, Department of Obstetrics, Gynecology, and Reproductive Medicine Poitiers University Hospital Centre, University of Poitiers, Poitiers, France
| | - Xavier Fritel
- Clinical Research Centree CIC1402, INSERM, Department of Obstetrics, Gynecology, and Reproductive Medicine Poitiers University Hospital Centre, University of Poitiers, Poitiers, France
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17
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Vale DB, Anttila A, Ponti A, Senore C, Sankaranaryanan R, Ronco G, Segnan N, Tomatis M, Žakelj MP, Elfström KM, Lönnberg S, Dillner J, Basu P. Invitation strategies and coverage in the population-based cancer screening programmes in the European Union. Eur J Cancer Prev 2019; 28:131-140. [PMID: 29570103 DOI: 10.1097/cej.0000000000000426] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this study was to describe the compliance of the population-based cancer screening programmes in the European Union Member States to the invitation strategies enumerated in the European Guidelines and the impact of such strategies on the invitational coverage. Experts in screening programme monitoring from the respective countries provided data. Coverage by invitation was calculated as the proportion of individuals in the target age range receiving a screening invitation over the total number of annualized eligible population. The invitation strategies of 30 breasts, 25 cervical and 27 colorectal national or regional population-based screening programmes are described. Individual mail invitations are sent by 28 breasts, 20 cervical and 25 colorectal screening programmes. Faecal occult blood test kits are sent by post in 17 of the colorectal cancer screening programmes. The majority of programmes claimed to have a population registry, although some use health insurance data as the database for sending invitations. At least 95% invitation coverage was reached by 16 breast, six cervical and five colorectal screening programmes. Majority of the programmes comply with the invitation strategies enumerated in the European guidelines, although there is still scope for improvements. Coverage by invitation is below the desirable level in many population-based cancer screening programmes in European Union.
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Affiliation(s)
- Diama B Vale
- Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, Brazil
| | | | - Antonio Ponti
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Carlo Senore
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | | | - Guglielmo Ronco
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Nereo Segnan
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Mariano Tomatis
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Maja P Žakelj
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Stefan Lönnberg
- Finnish Cancer Registry, Helsinki, Finland
- Cancer Registry of Norway, Oslo, Norway
| | | | - Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France
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18
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Establishment of a national cervical screening programme in Ireland, CervicalCheck: the first 6 years. Eur J Cancer Prev 2019; 27:158-163. [PMID: 27824660 DOI: 10.1097/cej.0000000000000323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The national cervical screening programme, CervicalCheck, commenced in Ireland in 2008. Free cervical smear tests are offered to over 1.2 million women aged 25-60 every 3 (aged 25-44) and 5 (aged 45-60) years. The purpose of this paper is to highlight the achievements and document the experience of the first 6 years of a new cervical screening programme. Data were extracted from the programme screening register and colposcopy management systems. SAS, version 9.4 was used for statistical analysis. Over 1.98 million smear tests were performed in over 1 million women during the first 6 years of the programme. Overall 5-year coverage at the end of the sixth year was 77.0%, where coverage is presented for the target population of women aged 25-60 years and is adjusted for hysterectomy rates. The numbers of women attending colposcopy increased significantly from 10 000 new patients attending for the first time in the first year to a peak of almost 17 500 in the third year. Increased capacity in colposcopy has delivered significant improvements in waiting times; the percentage of women referred to colposcopy offered an appointment within 8 weeks increased from 41.5% in year 1 to 93.4% in year 4 and has remained above the greater than 90% standard thereafter. The number of biopsies increased markedly, with 33 768 women being diagnosed with cervical intraepithelial neoplasia-grade 2 (CIN2), CIN3 or adenocarcinoma in situ and 860 being diagnosed with invasive cancer by the end of the sixth year. Lessons from CervicalCheck include the importance of capacity planning in programme delivery. The programme continues to evolve, particularly with the increased usage of human papillomavirus testing and planning for future testing of the human papillomavirus (HPV)-vaccinated cohort.
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19
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Csanádi M, de Kok IM, Heijnsdijk EA, Anttila A, Heinävaara S, Pitter JG, Széles G, Ivanuš U, Priaulx J, Veerus P, Senore C, Koning HJD, Vokó Z. Key indicators of organized cancer screening programs: Results from a Delphi study. J Med Screen 2019; 26:120-126. [PMID: 30621498 DOI: 10.1177/0969141318820362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To maximize benefits and reduce potential harms of organized cancer screening programs in Europe, monitoring, quality assurance, and evaluation of long-term impact are required. We aimed to identify the most important indicators to be collected and reported. The study was designed to establish a consensus within a European-level working group and suggest a manageable list of key indicators. Methods We conducted a Delphi study among policymakers, researchers, and program coordinators who were experts in breast, cervical, or colorectal cancer screening. Study participants evaluated the importance of screening indicators on a 5-point Likert scale. Results The top 10 indicators by study participants were interval cancer rate, detection rate, screening attendance, screening coverage, cancer incidence, cause-specific mortality, proportion of persons attending further assessment after a positive screen test result, proportion of persons attending a treatment after diagnosis, invitation coverage, and distribution of cancers by mode of detection. Performance indicators were generally considered more important than outcome indicators. Subgroup analyses by cancer types showed similar results, and only cervical cancer screening experts had slightly different preferences. Subgroup analyses by experts’ roles indicated that policymakers found different indicators important compared with researchers or program coordinators, probably because of their different point of view on screening. Conclusion The implication of our priority ranking is twofold: it serves as an initial guidance for countries that have not yet established a system to collect data, and as a checklist for those where data collection is already established, to assess the comprehensiveness of their system.
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Affiliation(s)
| | - Inge McM de Kok
- 2 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Eveline Am Heijnsdijk
- 2 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | - Urška Ivanuš
- 4 Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Piret Veerus
- 6 National Institute for Health Development, Tallinn, Estonia
| | - Carlo Senore
- 7 CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Harry J de Koning
- 2 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Zoltán Vokó
- 1 Syreon Research Institute, Budapest, Hungary
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20
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Kristiansen BK, Andersen B, Bro F, Svanholm H, Vedsted P. Direct notification of cervical cytology results to women improves follow-up in cervical cancer screening - A cluster-randomised trial. Prev Med Rep 2018; 13:118-125. [PMID: 30568870 PMCID: PMC6296289 DOI: 10.1016/j.pmedr.2018.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/23/2018] [Accepted: 11/22/2018] [Indexed: 11/27/2022] Open
Abstract
Up to half of all women do not receive follow-up as recommended after cervical cytology testing and are thus at increased risk of dysplasia progression. Women from lower social positions are at increased risk of not receiving follow-up. Sample takers, often general practitioners, convey results to women, but communication problems constitute a challenge. We aimed to investigate the effect of direct notification of cervical cytology results on follow-up rates. In a 1:1 cluster-randomised controlled trial, we assessed if having the pathology department convey cervical cytology results directly to the investigated women improved timely follow-up, compared with conveying the results via the general practitioner as usual. All women with a cervical cytology performed in a general practice in the Central Denmark Region (2013-2014) and receiving follow-up recommendation were included (n = 11,833). The proportion of women without timely follow-up was lower in the group with direct notifications than in the control group of women receiving usual care, regardless of age, educational status, cohabitation status and ethnicity. Among the women with the most severe cervical cytology diagnoses who are recommended gynaecological follow-up within 3 months, the percentage without timely follow-up was 15.1% in the intervention group and 19.5% in the control group (prevalence difference: -0.04 (95%CI: -0.07; -0.02)). Improved timely follow-up was also observed for women with a recommendation to have follow-up performed at 3 and 12 months. Cervical cytology results conveyed directly by letter to women increased the proportion of women with timely follow-up without raising inequality in follow-up measured by social position. Trial registration: ClinicalTrials.gov (TRN: NCT02002468) 29 November 2013.
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Key Words
- AGC, Atypical Glandular Cells
- AIS, adenocarcinoma in situ
- ASC-H, atypical squamous cells cannot exclude HSIL
- ASC-US, Atypical Squamous Cells of Undetermined Significance
- CCU, cancer of the cervix uteri
- CDR, Central Denmark Region
- DPDB, Danish National Pathology Registry and Data Bank
- Early detection of cancer
- GP, general practitioner
- General practice
- HSIL, High-grade Squamous Intraepithelial Lesion
- ICC, intra-cluster correlation coefficient
- LSIL, Low-grade Squamous Intraepithelial Lesion
- Mass screening
- PD, prevalence differences
- PR, prevalence ratio
- Quality of health care
- SNOMED, Systematized Nomenclature of Medicine
- Socioeconomic factors
- Uterine cervical dysplasia
- hrHPV-pos., high-risk Human Papilloma Virus positive
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Affiliation(s)
- Bettina Kjær Kristiansen
- Research Unit for General Practice, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark.,Department for Public Health Programmes, Randers Regional Hospital, 8930 Randers, Denmark
| | - Berit Andersen
- Department for Public Health Programmes, Randers Regional Hospital, 8930 Randers, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Hans Svanholm
- Department of Pathology, Randers Regional Hospital, 8930 Randers, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
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21
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Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing. Viruses 2018; 10:v10120729. [PMID: 30572620 PMCID: PMC6315375 DOI: 10.3390/v10120729] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 12/25/2022] Open
Abstract
Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.
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22
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Bucchi L, Baldacchini F, Mancini S, Ravaioli A, Giuliani O, Vattiato R, Falcini F, Giorgi Rossi P, Campari C, Canuti D, Di Felice E, Sassoli de Bianchi P, Ferretti S, Bertozzi N, Biggeri A. Estimating the impact of an organised screening programme on cervical cancer incidence: A 26-year study from northern Italy. Int J Cancer 2018; 144:1017-1026. [PMID: 30120770 DOI: 10.1002/ijc.31806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 11/09/2022]
Abstract
The impact of the organised cervical cancer (CC) screening programmes implemented in Europe since the 1990s has been insufficiently evaluated. We investigated the changes in CC incidence following the introduction of a screening programme in the Emilia-Romagna Region (northern Italy). The study period was 1988-2013. The programme, targeting women aged 25-64 years (1,219,000 in 2018), started in 1998. The annual incidence rates that would be expected in 1998-2013 in the absence of screening were estimated, first, by analysing the annual rates in 1988-1997 with a log-linear model and, second, by analysing the annual rates in 1988-2013 with an age-period model in which the period effect was enforced to be linear. Cervical adenocarcinoma incidence trend over the entire period was used to validate both estimates. Observed annual rates were compared to the two series of expected ones with the incidence rate ratio (IRR). Incidence remained stable during 1988-1997, peaked in 1998 and then decreased until 2007, when it stabilised. The two series of expected rates were virtually coincident and their trends roughly paralleled the stable adenocarcinoma incidence trend. After 2007, the median IRR was 0.60 (95% confidence interval, 0.45-0.81) based on the log-linear model and 0.58 (95% confidence interval, 0.34-0.97) based on the age-period model. Thirty-six to seventy-five CC cases were prevented annually for an average annual frequency of 6.5 per 100,000 women in the target population. In summary, consistent circumstantial evidences were obtained that the organised screening programme brought about a 40% reduction in annual CC incidence after 10 years.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy.,Cancer Prevention Unit, Local Health Authority, Forlì, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Local Health Authority and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Cinzia Campari
- Cancer Screening Unit, Local Health Authority and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Debora Canuti
- Cancer Screening Unit, Local Health Authority, Rimini, Italy
| | - Enza Di Felice
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | | | - Stefano Ferretti
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Nicoletta Bertozzi
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Annibale Biggeri
- Department of Statistics, Computer Science, and Applications "G. Parenti", University of Florence, Florence, Italy
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Terlan RJ, Cesar JA. Não realização de citopatológico de colo uterino entre gestantes no extremo sul do Brasil: prevalência e fatores associados. CIENCIA & SAUDE COLETIVA 2018; 23:3557-3566. [DOI: 10.1590/1413-812320182311.35162016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 01/08/2017] [Indexed: 11/22/2022] Open
Abstract
Resumo O câncer do colo do útero é o terceiro tumor mais frequente na população feminina e o teste citopatológico (CP) a principal estratégia para o rastreamento. Este estudo mediu a prevalência e os fatores associados à não realização de CP entre gestantes maiores de 25 anos, durante o pré-natal, no município de Rio Grande, RS, em 2013. A análise multivariável utilizou regressão de Poisson avaliada por meio de razão de prevalências (RP). Dentre as 1474 gestantes incluídas no estudo, 21,6% (IC95% 19,5%-23,7%) não realizaram CP nos últimos três anos. Na análise ajustada, a RP para não realização entre puérperas com escolaridade entre 0-4 anos foi 2,14 (IC95%:1,35-3,38) em comparação àquelas com 12 anos ou mais. Ter referido aborto prévio e consumido álcool durante a gestação mostrou RP = 1,38 (1,10-1,73) e 1,39 (1,04-1,84) de não fazê-lo em relação às demais, respectivamente. Realizar 1-5 consultas de pré-natal conferiu RP = 1,35 (1,03-1,77) em relação às demais. Evidencia-se proporção expressiva de não realização de CP e não cumprimento de recomendação básica do Ministério da Saúde. Os profissionais de saúde deveriam reforçar a necessidade de realização deste exame, bem como busca ativa na comunidade das gestantes com o perfil aqui descrito.
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Májek O, Anttila A, Arbyn M, van Veen EB, Engesæter B, Lönnberg S. The legal framework for European cervical cancer screening programmes. Eur J Public Health 2018; 29:345-350. [DOI: 10.1093/eurpub/cky200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ondřej Májek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Institute of Health Information and Statistics, Praha 2, Czech Republic
| | | | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | | | - Birgit Engesæter
- The Norwegain cervical cancer screening programme, Cancer Registry of Norway, Oslo, Norway
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Priaulx J, de Koning HJ, de Kok IMCM, Széles G, McKee M. Identifying the barriers to effective breast, cervical and colorectal cancer screening in thirty one European countries using the Barriers to Effective Screening Tool (BEST). Health Policy 2018; 122:1190-1197. [PMID: 30177278 DOI: 10.1016/j.healthpol.2018.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/09/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022]
Abstract
The aim of this study was to identify barriers to effective breast, cervical and colorectal cancer screening programmes throughout the whole of the European region using the Barriers to Effective Screening Tool (BEST). The study was part of the scope of the EU-TOPIA (TOwards imProved screening for breast, cervical and colorectal cancer In All of Europe) project and respondents were European screening organisers, researchers and policymakers taking part in a workshop for the project in Budapest in September 2017. 67 respondents from 31 countries responded to the online survey. The study found that there are many barriers to effective screening throughout the system from identification of the eligible population to ensuring appropriate follow-up and treatment for the three cancers. The most common barriers were opportunistic screening, sub-optimal participation, limited capacity (including trained human resource), inadequate and/or disjointed information technology systems and complex administration procedures. Many of the barriers were reported consistently across different countries. This study identified the barriers that, in general, require further investment of resources.
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Affiliation(s)
| | - Harry J de Koning
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | - Inge M C M de Kok
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK.
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26
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Dutta T, Meyerson B, Agley J. African cervical cancer prevention and control plans: A scoping review. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Arbyn M, Van Veen EB, Andersson K, Bogers J, Boulet G, Bergeron C, von Knebel-Doeberitz M, Dillner J. Cervical Cytology Biobanking in Europe. Int J Biol Markers 2018; 25:117-25. [DOI: 10.1177/172460081002500301] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A cervical cytology biobank (CCB) is an extension of current cytopathology laboratory practice consisting in the systematic storage of Pap smears or liquid-based cytology samples from women participating in cervical cancer screening with the explicit purpose to facilitate future scientific research and quality audit of preventive services. A CCB should use an internationally agreed uniform cytology terminology, be integrated in a national or regional screening registry, and be linked to other registries (histology, cancer, vaccination). Legal and ethical principles concerning personal integrity and data safety must be respected strictly. Biobank-based studies require approval of ethical review boards. A CCB is an almost inexhaustible resource for fundamental and applied biological research. In particular, it can contribute to answering questions on the natural history of HPV infection and HPV-induced lesions and cancers, screening effectiveness, exploration of new biomarkers, and surveillance of the short- and long-term effects of the introduction of HPV vaccination. To understand the limitations of CCB, more studies are needed on the quality of samples in relation to sample type, storage procedures, and duration of storage.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels - Belgium
| | | | - Kristin Andersson
- Department of Medical Microbiology, Lund University, Malmö University Hospital, Malmö - Sweden
| | - Johannes Bogers
- Applied Molecular Biology Research Group (AMBIOR), Laboratory for Cell and Tissue Research, University of Antwerp - Belgium
| | - Gaëlle Boulet
- Applied Molecular Biology Research Group (AMBIOR), Laboratory for Cell and Tissue Research, University of Antwerp - Belgium
| | | | | | - Joakim Dillner
- Department of Medical Microbiology, Lund University, Malmö University Hospital, Malmö - Sweden
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Performance indicators in a newly established organized cervical screening programme: registry-based analysis in the Czech Republic. Eur J Cancer Prev 2018; 26:232-239. [PMID: 26908155 DOI: 10.1097/cej.0000000000000236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2008, the organized Czech National Cervical Cancer Screening Programme (CNCCSP) was initiated by transformation of the existing opportunistic efforts. The aim of our study was to examine recent cervical cancer burden trends and to assess the quality of the Czech National Cervical Cancer Screening Programme using a set of standard performance indicators. Our study utilized data from the national Cervical Cancer Screening Registry and the Czech National Cancer Registry. We computed internationally accepted indicators and assessed time trends and variability among screening centres. Between 1995 and 2011, the incidence of age-standardized cervical cancer decreased by 21% (1023 cases in 2011), and the mortality decreased by 35% (399 deaths in 2011). The annual coverage of the target population by cervical screening increased to 56% in 2013 (as compared with 35% in 2001). If we consider a 2-year interval (2012-2013), the estimated coverage was 77%. Over two million women underwent screening in 2013; 96% of them had a negative result. About 0.2% of smears showed cytological signs of a high-grade intraepithelial lesion or a malignancy, and the estimated positive predictive value for advanced intraepithelial neoplasia (cervical intraepithelial neoplasia grade 2+) was 79.6%. However, performance indicators show considerable heterogeneity between screening centres. The reported values of performance indicators are in line with the results of programmes that have previously been shown to be successful in terms of decreasing the cervical cancer burden, and are promising with respect to an even more pronounced decrease in cervical cancer mortality in the near future, provided that continuous quality improvement can be maintained. Linkage studies between screening, cancer and cause-of-death registers can provide further information on screening effectiveness and validity issues.
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Effect of Cervical Cancer Screening Programs on Preterm Birth: A Decision and Cost-Effectiveness Analysis. Obstet Gynecol 2017; 130:1207-1217. [PMID: 29112652 DOI: 10.1097/aog.0000000000002366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the effect of age at initiation and interval of cervical cancer screening in women of reproductive age on the risk of future preterm birth and subsequent adverse neonatal outcome relative to maternal life-years gained and cost of both screening and preterm birth. METHODS In this decision and cost-effectiveness analysis, we compared eight cytology-based screening programs varying in age of onset (21, 24, 25, 27, or 30 years) and screening interval (3 or 5 years) in a fictive cohort of 100,000 women. We used the microsimulation screening analysis model to estimate number of cervical intraepithelial neoplasia diagnoses, large loop excisions of the transformation zone (LLETZs), life-years gained, cervical cancer cases, deaths, and costs of screening and treatment. We used the number of LLETZs to calculate additional preterm births, subsequent neonatal morbidity, mortality, and associated costs. RESULTS The number of LLETZs per 100,000 women varied from 9,612 for the most intensive screening (every 3 years from age 21 years) to 4,646 for the least intensive screening (every 5 years from age 30 years). Compared with the least intensive program, the most intensive program increased maternal life-years gained by 9% (10,728 compared with 9,839), decreased cervical cancer cases by 67% (52 compared with 158), and cervical cancer deaths by 75% (four compared with 16) at the expense of 250% (158 compared with 45) more preterm births and 320% (four compared with one) more neonatal deaths while increasing total costs by $55 million ($77 compared with $23 million). The number of maternal life-years gained per additional preterm birth varied from 68 to 258 with subsequent total costs per maternal life-years gained of $7,212 and $2,329. CONCLUSION Cervical cancer screening every 3 years and subsequent treatment in women aged younger than 30 years yield limited life-years but may have substantial perinatal adverse effects. Consequently, women who plan to have children may benefit from a more cautious screening approach, taking into account their risk for both cancer and preterm birth.
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Ó Céilleachair A, O'Mahony JF, O'Connor M, O'Leary J, Normand C, Martin C, Sharp L. Health-related quality of life as measured by the EQ-5D in the prevention, screening and management of cervical disease: A systematic review. Qual Life Res 2017; 26:2885-2897. [PMID: 28653217 DOI: 10.1007/s11136-017-1628-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Cost-effectiveness analyses (CEAs) of screening can be highly sensitive to the health-related quality of life (HRQoL) effects of screen tests and subsequent treatment. Accordingly, accurate assessment of HRQoL is essential. We reviewed the literature regarding HRQoL in cervical prevention and management in order to appraise the current evidence regarding this important input to CEA. METHODS We searched the MEDLINE, Scopus and EconLit databases for studies that estimated HRQoL in cervical cancer prevention and management published January 1995-December 2015. The primary inclusion criterion was for studies that assess HRQoL using the EQ-5D. Data were abstracted from eligible studies on setting, elicitation group, sample size, elicitation instruments, health state valuations, study design and follow-up. We assessed the quality and comparability of the studies with a particular focus on the HRQoL reported across states and groups. RESULTS Fifteen papers met the inclusion criteria. Most used patient elicitation groups (n = 11), 2 used the general public and 2 used a mix of both. Eight studies were cross-sectional and seven were longitudinal. Six studies used both the EQ-5D-3L and the EQ-VAS together with other measures of overall HRQoL or condition-specific instruments. Extensive heterogeneity was observed across study characteristics. CONCLUSIONS Our results reveal the challenges of sourcing reliable estimates of HRQoL for use in CEAs of cervical cancer prevention and treatment. The EQ-5D appears insufficiently sensitive for some health states. A more general problem is the paucity of HRQoL estimates for many health states and their change over time.
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Affiliation(s)
- A Ó Céilleachair
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland.
| | - J F O'Mahony
- Centre for Health Policy and Management, Trinity College, Dublin, Ireland
| | - M O'Connor
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland
| | - J O'Leary
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - C Normand
- Centre for Health Policy and Management, Trinity College, Dublin, Ireland
| | - C Martin
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - L Sharp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Chatzistamatiou K, Chatzaki Ε, Constantinidis Τ, Nena E, Tsertanidou A, Agorastos T. Self-collected cervicovaginal sampling for site-of-care primary HPV-based cervical cancer screening: a pilot study in a rural underserved Greek population. J OBSTET GYNAECOL 2017. [PMID: 28631511 DOI: 10.1080/01443615.2017.1323197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In the present pilot study, the feasibility of a site-of-care cervicovaginal self-sampling methodology for HPV-based screening was tested in 346 women residing in underserved rural areas of Northern Greece. These women provided self-collected cervicovaginal sample along with a study questionnaire. Following molecular testing, using the cobas® HPV Test, Roche®, HPV positive women, were referred to colposcopy and upon abnormal findings, to biopsy and treatment. Participation rate was 100%. Regular pap-test examination was reported for 17.1%. Among hrHPV testing, 11.9% were positive and colposcopy/biopsy revealed 2 CIN3 cases. Non-compliance was the most prevalent reason for no previous attendance. Most women reported non-difficulty and non-discomfort in self-sampling (77.6% and 82.4%, respectively). They would choose self-sampling over clinician-sampling (86.2%), and should self-sampling being available, they would test themselves more regularly (92.3%). In conclusion, self-sampling is feasible and well-accepted for HPV-based screening, and could increase population coverage in underserved areas, helping towards successful prevention.
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Affiliation(s)
- Kimon Chatzistamatiou
- a 4th Department of Obstetrics and Gynecology , Hippokratio Hospital of Thessaloniki , Thessaloniki , Greece
| | - Εkaterini Chatzaki
- b Laboratory of Pharmacology , Medical School, Democritus University of Thrace , Alexandroupolis , Greece
| | - Τheocharis Constantinidis
- c Peripheral Laboratory of Public Health , Hellenic Center for Disease Control and Prevention, Ministry of Health , Alexandroupolis , Greece
| | - Evangelia Nena
- d Laboratory of Hygiene and Environmental Protection , Medical School, Democritus University of Thrace , Alexandroupolis , Greece
| | - Athena Tsertanidou
- a 4th Department of Obstetrics and Gynecology , Hippokratio Hospital of Thessaloniki , Thessaloniki , Greece
| | - Theodoros Agorastos
- a 4th Department of Obstetrics and Gynecology , Hippokratio Hospital of Thessaloniki , Thessaloniki , Greece
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Larsen MB, Mikkelsen EM, Jeppesen U, Svanholm H, Andersen B. The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional study. BMC Health Serv Res 2017. [PMID: 28633673 PMCID: PMC5477757 DOI: 10.1186/s12913-017-2371-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND High coverage of a screening program is essential to program success. Many European screening programs cover only 10-80% of their target population. A possible explanation for the low coverage may be that some women in the screening population have had a total hysterectomy, thus they are not at risk of cervical cancer. The aim of this study was to identify the prevalence of hysterectomy in the target population of the Danish National Cervical Cancer Screening Program (NCCSP) and to recalculate coverage after excluding women with total hysterectomy. Furthermore, to analyze the association between hysterectomy and sociodemographic factors within the screening population. METHODS A population-based cross-sectional study using register data on all women in the target population of the NCCSP on January 12, 2012 (women born January 12, 1947, to January 12, 1986). The total coverage included women with hysterectomy in the target population whereas the recalculated coverage was calculated excluding women with total hysterectomy. To test the differences between the total coverage and the recalculated coverage, a two-sample z-test between the proportion of covered hysterectomized women and the proportion of covered non-hysterectomised women were used. A logistic regression model adjusted for age and sociodemographic characteristics was used to analyze the association between sociodemographic factors and total hysterectomy. RESULTS The coverage among women aged 26-49 years and 55-64 years were 77.4% and 72.7%, respectively. The recalculated coverage was 78.2% (26-49 years) and 79.4% (55-64 years). Recalculating the coverage did not result in coverage higher than 82.7% at any age. The effect of excluding women with total hysterectomy increased with age, reaching its maximum of 8 % points for the oldest women. Women with higher socioeconomic status (higher education and higher disposable income) had lower odds of being hysterectomized compared to other women. Also, immigrants and descendants had lower odds of being hysterectomized compared to ethnic Danes. CONCLUSIONS Excluding women with total hysterectomy only partly explained the low coverage of the NCCSP. Thus, initiatives must be made to improve acceptability of and accessibility to the NCCSP, especially in the youngest and the oldest women.
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Affiliation(s)
- Mette Bach Larsen
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark.
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé, 43-45 8200, Aarhus N, Denmark
| | - Ulla Jeppesen
- Department of Gynaecology and Obstetrics, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark
| | - Hans Svanholm
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark.,Department of Pathology, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark
| | - Berit Andersen
- Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark
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Giorgi Rossi P, Carrozzi G, Federici A, Mancuso P, Sampaolo L, Zappa M. Invitation coverage and participation in Italian cervical, breast and colorectal cancer screening programmes. J Med Screen 2017; 25:17-23. [DOI: 10.1177/0969141317704476] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives In Italy, regional governments organize cervical, breast and colorectal cancer screening programmes, but there are difficulties in regularly inviting all the target populations and participation remains low. We analysed the determinants associated with invitation coverage of and participation in these programmes. Methods We used data on screening programmes from annual Ministry of Health surveys, 1999–2012 for cervical, 1999–2011 for breast and 2005–2011 for colorectal cancer. For recent years, we linked these data to the results of the national routine survey on preventive behaviours to evaluate the effect of spontaneous screening at Province level. Invitation and participation relative risk were calculated using Generalized Linear Models. Results There is a strong decreasing trend in invitation coverage and participation in screening programmes from North to South Italy. In metropolitan areas, both invitation coverage (rate ratio 0.35–0.96) and participation (rate ratio 0.63–0.88) are lower. An inverse association exists between spontaneous screening and both screening invitation coverage (1–3% decrease in invitation coverage per 1% spontaneous coverage increase) and participation (2% decrease in participation per 1% spontaneous coverage increase) for the three programmes. High recall rate has a negative effect on invitation coverage in the next round for breast cancer (1% decrease in invitation per 1% recall increase). Conclusions Organizational and cultural changes are needed to better implement cancer screening in southern Italy.
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Affiliation(s)
- Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, AUSL, Reggio Emilia, Italy
- Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Giuliano Carrozzi
- Servizio di Epidemiologia e Comunicazione del rischio, AUSL, Modena, Italy
- PASSI Survey Technical Group, Istituto Superiore di Sanità, Rome, Italy
| | | | - Pamela Mancuso
- Servizio Interaziendale di Epidemiologia, AUSL, Reggio Emilia, Italy
- Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Letizia Sampaolo
- Servizio di Epidemiologia e Comunicazione del rischio, AUSL, Modena, Italy
| | - Marco Zappa
- Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
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Trapero-Bertran M, Acera Pérez A, de Sanjosé S, Manresa Domínguez JM, Rodríguez Capriles D, Rodriguez Martinez A, Bonet Simó JM, Sanchez Sanchez N, Hidalgo Valls P, Díaz Sanchis M. Cost-effectiveness of strategies to increase screening coverage for cervical cancer in Spain: the CRIVERVA study. BMC Public Health 2017; 17:194. [PMID: 28196467 PMCID: PMC5309977 DOI: 10.1186/s12889-017-4115-0] [Citation(s) in RCA: 14] [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: 05/17/2016] [Accepted: 02/06/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of the study is to carry out a cost-effectiveness analysis of three different interventions to promote the uptake of screening for cervical cancer in general practice in the county of Valles Occidental, Barcelona, Spain. METHODS Women aged from 30 to 70 years (n = 15,965) were asked to attend a general practice to be screened. They were randomly allocated to one of four groups: no intervention group (NIG); one group where women received an invitation letter to participate in the screening (IG1); one group where women received an invitation letter and informative leaflet (IG2); and one group where women received an invitation letter, an informative leaflet and a phone call reminder (IG3). Clinical effectiveness was measured as the percentage increase in screening coverage. A cost-effectiveness analysis was performed from the perspective of the public health system with a time horizon of three to five years - the duration of the randomised controlled clinical trial. In addition, a deterministic sensitivity analysis was performed. Results are presented according to different age groups. RESULTS The incremental cost-effectiveness ratio (ICER) for the most cost-effective intervention, IG1, compared with opportunistic screening was € 2.78 per 1% increase in the screening coverage. The age interval with the worst results in terms of efficiency was women aged < 40 years. CONCLUSIONS In a population like Catalonia, with around 2 million women aged 30 to 70 years and assuming that 40% of these women were not attending general practice to be screened for cervical cancer, the implementation of an intervention to increase screening coverage which consists of sending a letter would cost on average less than € 490 for every 1000 women. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01373723 .
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Affiliation(s)
- Marta Trapero-Bertran
- Economy and Business Organisation Department, Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
- Centre for Research in Economics and Health (CRES), University Pompeu Fabra, c/Immaculada 22, 08017 Barcelona, Spain
| | - Amelia Acera Pérez
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol. Sabadell, Barcelona, Spain
- Grup de Recerca GRASSIR reconegut per la Generalitat de Catalunya SGR 2014-2016, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBERESP), Barcelona, Spain
| | - Josep Maria Manresa Domínguez
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol. Sabadell, Barcelona, Spain
- Departament de Infermeria, Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Diego Rodríguez Capriles
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain
| | - Ana Rodriguez Martinez
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain
| | | | - Norman Sanchez Sanchez
- Sistemes d’Informació Sanitària, SAP Vallés Occidental, Institut Catala de la Salut, Sabadell, Barcelona, Spain
| | - Pablo Hidalgo Valls
- SAP Vallés Occidental, Institut Català de la Salut, Sabadell, Barcelona, Spain
| | - Mireia Díaz Sanchis
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBERESP), Barcelona, Spain
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Burton-Jeangros C, Cullati S, Manor O, Courvoisier DS, Bouchardy C, Guessous I. Cervical cancer screening in Switzerland: cross-sectional trends (1992-2012) in social inequalities. Eur J Public Health 2017; 27:167-173. [PMID: 28177486 PMCID: PMC5421499 DOI: 10.1093/eurpub/ckw113] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Incidence and mortality of cervical cancer declined thanks to Pap smear screening. However cervical cancer screening (CCS) inequalities are documented, including in high income countries. This population-based study aims to assess the importance and 20-year trends of CCS inequalities in Switzerland, where healthcare costs and medical coverage are among the highest in the world. Methods: We analyzed data from five waves of the population-based Swiss Health Interview Survey (SHIS) covering the period 1992–2012. Multivariable Poisson regression were used to estimate weighted prevalence ratios (PR) of CCS and 95% Confidence Intervals (CI) adjusting for socio-economic, socio-demographic characteristics, family status, health status, and use of healthcare. Results: The study included 32’651 women aged between 20 and 70 years old. Between 1992 and 2012, rates of CCS over the past 3 years fluctuated between 71.7 and 79.6% (adjusted P < 0.001). Lower CCS was observed among women with low education, low income, those having limited emotional support, who were non-Swiss, single, older, living in non-metropolitan area or in the French-speaking region, overweight. Over the analyzed period, differences in CCS across age groups diminished while rates among women who visited a GP over the previous year, versus those who did not, increased. Conclusions : While important changes occurred in screening recommendations and in social circumstances of the targeted population, CCS rates remained fairly stable in Switzerland between 1992 and 2012. At the same time, inequalities in CCS persisted over that period.
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Affiliation(s)
- Claudine Burton-Jeangros
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
- Swiss National Centre of Competence for Research ‘LIVES - Overcoming Vulnerability: Life Course Perspectives’, Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Swiss National Centre of Competence for Research ‘LIVES - Overcoming Vulnerability: Life Course Perspectives’, Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
| | - Orly Manor
- School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | | | - Christine Bouchardy
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Department of Epidemiology, Emory University, Atlanta, GA, USA
- Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Pankakoski M, Heinävaara S, Sarkeala T, Anttila A. High lifetime probability of screen-detected cervical abnormalities. J Med Screen 2017; 24:201-207. [PMID: 28073308 PMCID: PMC5661699 DOI: 10.1177/0969141316685740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective Regular screening and follow-up is an important key to cervical cancer prevention; however, screening inevitably detects mild or borderline abnormalities that would never progress to a more severe stage. We analysed the cumulative probability and recurrence of cervical abnormalities in the Finnish organized screening programme during a 22-year follow-up. Methods Screening histories were collected for 364,487 women born between 1950 and 1965. Data consisted of 1 207,017 routine screens and 88,143 follow-up screens between 1991 and 2012. Probabilities of cervical abnormalities by age were estimated using logistic regression and generalized estimating equations methodology. Results The probability of experiencing any abnormality at least once at ages 30–64 was 34.0% (95% confidence interval [CI]: 33.3–34.6%). Probability was 5.4% (95% CI: 5.0–5.8%) for results warranting referral and 2.2% (95% CI: 2.0–2.4%) for results with histologically confirmed findings. Previous occurrences were associated with an increased risk of detecting new ones, specifically in older women. Conclusion A considerable proportion of women experience at least one abnormal screening result during their lifetime, and yet very few eventually develop an actual precancerous lesion. Re-evaluation of diagnostic criteria concerning mild abnormalities might improve the balance of harms and benefits of screening. Special monitoring of women with recurrent abnormalities especially at older ages may also be needed.
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Affiliation(s)
- Maiju Pankakoski
- 1 Finnish Cancer Registry, Helsinki, Finland.,2 Faculty of Medicine, University of Helsinki, Finland
| | - Sirpa Heinävaara
- 1 Finnish Cancer Registry, Helsinki, Finland.,2 Faculty of Medicine, University of Helsinki, Finland
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Li X, Zheng R, Li X, Shan H, Wu Q, Wang Y, Chen W. Trends of incidence rate and age at diagnosis for cervical cancer in China, from 2000 to 2014. Chin J Cancer Res 2017; 29:477-486. [PMID: 29353970 DOI: 10.21147/j.issn.1000-9604.2017.06.02] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To analyze the trends of incidence rate and age at diagnosis for cervical cancer incidence in China using population-based cancer registration data from 2000 to 2014. Methods Data were from National Central Cancer Registry of China. Crude incidence rates (CIRs), age-specific incidence rate, age-standardized incidence rates (ASIRs), age percentage distribution, standardized age percentage distribution, mean age at diagnosis and standardized mean age at diagnosis for cervical cancer in all areas of China, urban China and rural China were calculated separately. The world Segi's population was applied to remove the age structure influence. Joinpoint regression was performed to obtain average annual percent change (AAPC) and age-period-cohort analysis was used to examine the incidence trends. Results CIRs and ASIRs for cervical cancer increased in China from 2000 to 2014. The AAPC of ASIRs in China was at 9.2% [95% confidence interval (95% CI): 7.0%-11.5%, P<0.05], and the AAPC in rural areas was relatively high. The age-specific incidence rate in groups aged 0-69 years have significantly increased over time. Groups aged 40-69 years showed the highest incidence risk, and the annual percent changes (APCs) of incidence rate in groups aged 40-59 years in urban China and groups aged 0-49 years in rural China were more than 10%. For each age group, the urban-to-rural incidence rate ratios (IRRs) got close to 1 over time. There were clear birth cohort effects in successive generations born from 1940 to 1970 in China. In rural China, the standardized mean age at diagnosis had significantly declined by 5.18 years. In China, the main peak and secondary peak of standardized age percentages appeared in the groups aged 45-49 and 40-44 years, respectively. In rural China, the main peak of standardized age percentage moved from the group aged 55-59 years to the group aged 45-49 years, and the standardized age percentages of groups aged 25-34 years also increased. In China, the standardized age percentages has significantly increased in groups aged 35-64 and 30-64 years over time, and accounted for about 80% and 85% in 2014, respectively. Conclusions The cervical cancer incidence increased in China and the gap of incidence between urban and rural China was narrowed. The trends of increasing cervical cancer incidence among younger women existed in China, especially in rural China. A more appropriate screening, vaccination and health education strategies should be established.
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Affiliation(s)
- Xueting Li
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Rongshou Zheng
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xuemei Li
- School of Medical Technology, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
| | - Haibin Shan
- Beidaihe Center for Disease Control and Prevention, Qinhuangdao 066100, China
| | - Qi Wu
- Maternal and Child Health Hospital of Haizhu District, Guangzhou 510240, China
| | - Yan Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Wanqing Chen
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Leinonen MK, Campbell S, Klungsøyr O, Lönnberg S, Hansen BT, Nygård M. Personal and provider level factors influence participation to cervical cancer screening: A retrospective register-based study of 1.3 million women in Norway. Prev Med 2017; 94:31-39. [PMID: 27894911 DOI: 10.1016/j.ypmed.2016.11.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/14/2016] [Accepted: 11/24/2016] [Indexed: 11/24/2022]
Abstract
High coverage is essential for an effective screening programme. Here we present screening barriers and facilitators among 1.3 million women aged 25-69years eligible for screening within the Norwegian Cervical Cancer Screening Program (NCCSP). We defined non-adherence as no screening test in 2008-2012. We divided adherent women into those screened spontaneously, and those who had a smear after receiving a reminder from the NCCSP. Explanatory variables were extracted from several nationwide registers, and modelled by modified Poisson regression. In total, 34% of women were non-adherent. 31% of native Norwegians were non-adherent, compared to 50% of immigrants. Immigrant status was a strong predictor of non-adherence, but the vast majority of non-adherent women were still native Norwegians. Higher non-adherence rates were associated with having a male general practitioner (GP), a foreign GP, a young GP, and distance to the screening site. Being unmarried, having no children, having lower socioeconomic position and region of residence predicted non-adherence and, to a smaller extent, reminded adherence to screening. In contrast, previous experience with cervical abnormalities substantially increased adherence to screening. The population-based screening programme promotes equity by recruiting women who are less likely to participate spontaneously. However, socioeconomic disparities were evident in a country with a nationwide programme and a policy of equal access to health care. Initiatives aimed at removing practical and financial barriers to equitable screening delivery and at reducing the effect of sociodemographic attributes on screening participation are needed.
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Affiliation(s)
- Maarit K Leinonen
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway.
| | - Suzanne Campbell
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Ole Klungsøyr
- Department of Treatment Research, Division of Mental Health and Addiction, Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, 0424 Oslo, Norway
| | - Stefan Lönnberg
- Department of Cervical Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Bo T Hansen
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
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Constantinou P, Sicsic J, Franc C. Effect of pay-for-performance on cervical cancer screening participation in France. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2016; 17:10.1007/s10754-016-9207-3. [PMID: 28005224 DOI: 10.1007/s10754-016-9207-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/04/2016] [Indexed: 06/06/2023]
Abstract
Pay-for-performance (P4P) has been increasingly used across different healthcare settings to incentivize the provision of targeted services. In this study, we investigated the effect of a nationwide P4P scheme for general practitioners implemented in 2012 in France, on cervical cancer screening practices. Using data from a nationally representative permanent sample of health insurance beneficiaries, we analyzed smear test use of eligible women for the years 2006-2014. Our longitudinal sample was an unbalanced panel comprising 180,167 women eligible from 1 to 9 years each. We took into account that during our study period some women were exposed to another incentive for screening participation: the implementation in 2010 of organized screening (OS) in a limited number of areas. To evaluate the effect of P4P, we defined three different measures of smear utilization. For each measure, we specified binary panel-data models to estimate annual probabilities and to compare each estimate to the 2011 baseline level. To explore the combined effect of P4P and OS in areas exposed to both incentives, we computed interaction terms between year dummies and area of residence. We found that P4P had a modest positive effect on recommended screening participation. This effect is likely to be transient as annual smear use, both for the whole sample and among women overdue for screening, increased only in 2013 and decreased again in 2014. The combined effect of P4P and OS on screening participation was not cumulative during the first years of coexistence.
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Affiliation(s)
- Panayotis Constantinou
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France.
| | - Jonathan Sicsic
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France
| | - Carine Franc
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France
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Tranberg M, Bech BH, Blaakær J, Jensen JS, Svanholm H, Andersen B. Study protocol of the CHOiCE trial: a three-armed, randomized, controlled trial of home-based HPV self-sampling for non-participants in an organized cervical cancer screening program. BMC Cancer 2016; 16:835. [PMID: 27809810 PMCID: PMC5094020 DOI: 10.1186/s12885-016-2859-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 10/11/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The effectiveness of cervical cancer screening programs is challenged by suboptimal participation and coverage. Offering cervico-vaginal self-sampling for human papillomavirus testing (HPV self-sampling) to non-participants can increase screening participation. However, the effect varies substantially among studies, especially depending on the approach used to offer HPV self-sampling. The present trial evaluates the effect on participation in an organized screening program of a HPV self-sampling kit mailed directly to the home of the woman or mailed to the woman's home on demand only, compared with the standard second reminder for regular screening. METHODS/DESIGN The CHOiCE trial is a parallel, randomized, controlled, open-label trial. It will include 9327 women aged 30-64 years who are living in the Central Denmark Region and who have not participated in cervical cancer screening after an invitation and one reminder. The women will be equally randomized into three arms: 1) Directly mailed a second reminder including a HPV self-sampling kit; 2) Mailed a second reminder offering a HPV self-sampling kit, to be ordered by e-mail, text message, phone, or through a webpage; and 3) Mailed a second reminder for a practitioner-collected sample (control group). The primary outcome will be the proportion of women in the intervention groups who participate by returning their HPV self-sampling kit or have a practitioner-collected sample compared with the proportion of women who have a practitioner-collected sample in the control group at 90 and 180 days after mail out of the second reminders. Per-protocol and intention-to-treat analyses will be performed. The secondary outcome will be the proportion of women with a positive HPV self-collected sample who attend follow-up testing at 30, 60, or 90 days after mail out of the results. DISCUSSION The CHOiCE trial will provide strong and important evidence allowing us to determine if and how HPV self-sampling can be used to increase participation in cervical cancer screening. This trial therefore has the potential to improve prevention and reduce the number of deaths caused by cervical cancer. TRIAL REGISTRATION Current Controlled Trials NCT02680262 . Registered 10 February 2016.
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Affiliation(s)
- Mette Tranberg
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark.
| | - Bodil Hammer Bech
- Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Jan Blaakær
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | - Hans Svanholm
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark.,Department of Pathology, Randers Regional Hospital, Østervangsvej 48, 8930, Randers, NØ, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Nahvijou A, Daroudi R, Tahmasebi M, Amouzegar Hashemi F, Rezaei Hemami M, Akbari Sari A, Barati Marenani A, Zendehdel K. Cost-Effectiveness of Different Cervical Screening Strategies in Islamic Republic of Iran: A Middle-Income Country with a Low Incidence Rate of Cervical Cancer. PLoS One 2016; 11:e0156705. [PMID: 27276093 PMCID: PMC4898767 DOI: 10.1371/journal.pone.0156705] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/18/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Invasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC. METHODS We constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results. RESULTS We found that the prevented mortalities for the 11 strategies compared with no screening varied from 26% to 64%. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was $8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran. CONCLUSION We recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer.
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Affiliation(s)
- Azin Nahvijou
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I. R. Iran
| | - Rajabali Daroudi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, I. R. Iran
| | - Mamak Tahmasebi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I. R. Iran
| | - Farnaz Amouzegar Hashemi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I. R. Iran
| | - Mohsen Rezaei Hemami
- Institute of Health & Wellbeing Health Economics & Health Technology Assessment University of Glasgow, Scotland, United Kingdom
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, I. R. Iran
| | - Ahmad Barati Marenani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, I. R. Iran
| | - Kazem Zendehdel
- Cancer Model Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I. R. Iran
- * E-mail:
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Elfström KM, Sparén P, Olausson P, Almstedt P, Strander B, Dillner J. Registry-based assessment of the status of cervical screening in Sweden. J Med Screen 2016; 23:217-226. [PMID: 27068429 DOI: 10.1177/0969141316632023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 01/15/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Comprehensive nationwide monitoring and evaluation of screening through registry-based review of key indicators is necessary for programme optimization, especially as new tests and strategies are introduced. We aimed to investigate and report on the use of these key indicators in the Swedish programme. SETTING AND METHODS Organized population-based cervical screening targeting women aged 23-50 and 51-60 every three and five years, respectively, is regionally implemented in Sweden. All cytological and histopathological test results and invitations are exported to the National Cervical Screening Registry. We describe the methods to obtain registry-based quality indicators by age, region, and calendar period. RESULTS In 2013, there were 633,592 cervical smears in Sweden, of which 69% were organized smears resulting from an invitation. Screening test coverage for women aged 23-60 was 80% and similar for the previous decade, but varied greatly between and within counties over-time. Among women aged 23-25, test coverage increased dramatically during the previous six years, reaching 87% in 2013. The proportion of women with cytological high-grade cervical lesions found in cytology that had been followed-up with biopsy within one year was 97%. Major variations in cervical cancer incidence between counties were observed. CONCLUSIONS Registry-based analyses of key quality indicators provided the basis for prioritizing improvements of the organized cervical screening programme.
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Affiliation(s)
- K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Olausson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pouran Almstedt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Björn Strander
- Swedish Cervical Screening Registry, Regional Cancer Center, West Sweden, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Joakim Dillner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .,Swedish Cervical Screening Registry, Center for Cervical Cancer Prevention, Department of Pathology, Karolinska University Laboratory, Karolinska Hospital, Stockholm, Sweden
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Naber SK, de Kok IMCM, Matthijsse SM, van Ballegooijen M. The potential harms of primary human papillomavirus screening in over-screened women: a microsimulation study. Cancer Causes Control 2016; 27:569-81. [PMID: 26970740 PMCID: PMC4796367 DOI: 10.1007/s10552-016-0732-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is well acknowledged that HPV testing should not be performed at young age and at short intervals. Cytological screening practices have shown that over-screening, i.e., from a younger age and at shorter intervals than recommended, is hard to avoid. We quantified the consequences of a switch to primary HPV screening for over-screened women, taking into account its higher sensitivity but lower specificity than cytology. METHODS The health effects of using the HPV test instead of cytology as the primary screening method were determined with the MISCAN-Cervix model. We varied the age women start screening and the interval between screens. In the sensitivity analyses, we varied the background risk of cervical cancer, the HPV prevalence, the discount rate, the triage strategy after cytology, and the test characteristics of both cytology and the HPV test. RESULTS For women screened 5 yearly from age 30, 32 extra deaths per 100,000 simulated women were prevented when switching from primary cytology to primary HPV testing. For annual screening from age 20, such a switch resulted in 6 extra deaths prevented. It was associated with 9,044 more positive primary screens in the former scenario versus 76,480 in the latter. Under all conditions, for women screened annually, switching to HPV screening resulted in a net loss of quality-adjusted life years. CONCLUSION For over-screened women, the harms associated with a lower test specificity outweigh the life years gained when switching from primary cytology to primary HPV testing. The extent of over-screening should be considered when deciding on inclusion of primary HPV screening in cervical cancer screening guidelines.
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Affiliation(s)
- Steffie K Naber
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Inge M C M de Kok
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Suzette M Matthijsse
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Ribeiro JC, Andrade SRD. HEALTH SURVEILLANCE AND PAP TEST COVERAGE: INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2016. [DOI: 10.1590/0104-07072016005320015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This integrative review aimed to evidence in the literature health surveillance activities that contribute to the increased coverage of the cervical Pap smear. The search was undertaken between April and May 2014 in the databases LILACS, CINAHL, MEDLINE and Scopus, using the keywords health surveillance, cervix neoplasm prevention, and Papanicolaou test, in Portuguese, English and Spanish. We selected 341 articles, of which 33 met the inclusion criteria. In studies, the actions have been identified and grouped according to two main control practices of cervical cancer adopted in Brazil: primary prevention and secondary prevention, with emphasis on health promotion and prevention actions that contributed to the increased coverage of the cervical Pap smear.
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Bychkovsky BL, Ferreyra ME, Strasser-Weippl K, Herold CI, de Lima Lopes G, Dizon DS, Schmeler KM, Del Carmen M, Randall TC, Nogueira-Rodrigues A, de Carvalho Calabrich AF, St. Louis J, Vail CM, Goss PE. Cervical cancer control in Latin America: A call to action. Cancer 2015; 122:502-14. [DOI: 10.1002/cncr.29813] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/03/2015] [Accepted: 11/09/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Brittany L. Bychkovsky
- Department of Breast Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | | | | | - Christina I. Herold
- Department of Breast Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | - Gilberto de Lima Lopes
- Clinical Oncology, Cancer Institute of Sao Paulo State; Sao Paulo Brazil
- Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Don S. Dizon
- Massachusetts General Hospital Cancer Center, Harvard Medical School; Boston Massachusetts
| | | | - Marcela Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | - Tom C. Randall
- Global Oncology Initiative, Dana-Farber Harvard Cancer Center; Boston Massachusetts
- Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | | | | | - Jessica St. Louis
- The Global Cancer Institute; Boston Massachusetts
- Avon International Breast Cancer Research Program, Massachusetts General Hospital; Boston Massachusetts
| | - Caroline M. Vail
- The Global Cancer Institute; Boston Massachusetts
- Avon International Breast Cancer Research Program, Massachusetts General Hospital; Boston Massachusetts
- University of New England; Biddeford Maine
| | - Paul E. Goss
- The Global Cancer Institute; Boston Massachusetts
- Avon International Breast Cancer Research Program, Massachusetts General Hospital; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
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Knowledge of Cervical Cancer Screening among Women across Different Socio-Economic Regions of China. PLoS One 2015; 10:e0144819. [PMID: 26657110 PMCID: PMC4682831 DOI: 10.1371/journal.pone.0144819] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022] Open
Abstract
Background and Objective China has a high burden of cervical cancer (CC) and wide disparities in CC burden exist among different socio-economic regions. In order to reduce these disparities, China’s government launched the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in 2009. Understanding the factors associated with underutilization of CC screening among target populations is important to improve the screening participation rate, and a high participation rate is key to achieving the goals of a screening program. However, data on the knowledge of CC among target populations in program areas is lacking in China. This study will investigate the knowledge of CC prevention and control among women in specific project counties to develop a better understanding of factors that might influence CC screening participation in order to improve the implementation of the NCCSPRA. Materials and Methods A cross-sectional survey was conducted and face-to-face interview questionnaires were completed by 308 women who received CC screening services in 6 project counties of NCCSPRA across different socio-economic regions of China. ANOVA and Chi-square tests were used to compare the knowledge rates and scores across the different subgroups. Logistic regression was conducted to examine factors associated with knowledge level. Results The overall CC knowledge rate of the target population was only 19.5%. Regional socio-economic level, advice from doctors, age, and educational status were strong predictors of knowledge level of CC screening. Significantly lower knowledge rates and scores were identified in older women (55–64 years old), less educated women (with primary school or illiterate), women in less developed regions and women who did not receive any advice about screening results from doctors. Conclusion The knowledge of CC screening among women in the project counties of NCCSPRA was found to be very poor. Given the importance of knowledge in encouraging women to participate in screening is key to reducing CC burden in rural women in China, it is urgent that a targeted health promotion intervention is developed and implemented in project counties, especially targeting older women, women with less education and women in less developed regions, and focus on improving their CC knowledge and encouraging them to communicate with health care providers. The health promotion intervention targeting health care providers is also important to improve their knowledge of CC and provide best advice to women.
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Cervical carcinoma in the European Union: an update on disease burden, screening program state of activation, and coverage as of March 2014. Int J Gynecol Cancer 2015; 25:474-83. [PMID: 25695550 DOI: 10.1097/igc.0000000000000374] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Cervical cancer (CC) is defined as a disease of disparity. This is due to marked differences in CC incidence and mortality between developed and developing countries. As a continent, Europe is no exception. This study examines the state of activation of CC screening in the European Union as of March 2014, reviews CC incidence and mortality data, and highlights the initiatives adopted to extend program coverage to nonresponders. METHODS The present study is based on the most recent data available from PubMed-indexed journals, the Web sites of the health ministries of each member state, and the Web sites of national cancer observatories; failing these sources, information was sought in scientific journals published in the local language. RESULTS In 2003, the European Council recommended that priority be given to organized screening program activation. Nonetheless, a number of European Union member states still lack population-based organized screening programs, and few have implemented programs directed at disadvantaged populations. CONCLUSIONS Several investigations have demonstrated that the women at higher CC risk are unscreened and underscreened ones. Since then, several member states have made significant efforts to set up effective prevention programs by adopting international quality standards and centralizing screening organization and result evaluation. Several developed countries and some new central-eastern European member states have poorly organized prevention programs that result in poor women's health. Diagnosis of CC is emotionally traumatic, but it is highly preventable. When CC is found early, it is highly treatable and associated with long survival and good quality of life.
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O'Mahony JF, Naber SK, Normand C, Sharp L, O'Leary JJ, de Kok IMCM. Beware of Kinked Frontiers: A Systematic Review of the Choice of Comparator Strategies in Cost-Effectiveness Analyses of Human Papillomavirus Testing in Cervical Screening. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:1138-1151. [PMID: 26686801 DOI: 10.1016/j.jval.2015.09.2939] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 08/11/2015] [Accepted: 09/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To systematically review the choice of comparator strategies in cost-effectiveness analyses (CEAs) of human papillomavirus testing in cervical screening. METHODS The PubMed, Web of Knowledge, and Scopus databases were searched to identify eligible model-based CEAs of cervical screening programs using human papillomavirus testing. The eligible CEAs were reviewed to investigate what screening strategies were chosen for analysis and how this choice might have influenced estimates of the incremental cost-effectiveness ratio (ICER). Selected examples from the reviewed studies are presented to illustrate how the omission of relevant comparators might influence estimates of screening cost-effectiveness. RESULTS The search identified 30 eligible CEAs. The omission of relevant comparator strategies appears likely in 18 studies. The ICER estimates in these cases are probably lower than would be estimated had more comparators been included. Five of the 30 studies restricted relevant comparator strategies to sensitivity analyses or other subanalyses not part of the principal base-case analysis. Such exclusion of relevant strategies from the base-case analysis can result in cost-ineffective strategies being identified as cost-effective. CONCLUSIONS Many of the CEAs reviewed appear to include insufficient comparator strategies. In particular, they omit strategies with relatively long screening intervals. Omitting relevant comparators matters particularly if it leads to the underestimation of ICERs for strategies around the cost-effectiveness threshold because these strategies are the most policy relevant from the CEA perspective. Consequently, such CEAs may not be providing the best possible policy guidance and lead to the mistaken adoption of cost-ineffective screening strategies.
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Affiliation(s)
- James F O'Mahony
- Department of Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Steffie K Naber
- Department of Public Health, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Charles Normand
- Department of Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - John J O'Leary
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland; Department of Pathology, Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Inge M C M de Kok
- Department of Public Health, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
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Verdoodt F, Jentschke M, Hillemanns P, Racey CS, Snijders PJF, Arbyn M. Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: a systematic review and meta-analysis of randomised trials. Eur J Cancer 2015; 51:2375-85. [PMID: 26296294 DOI: 10.1016/j.ejca.2015.07.006] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/17/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Population coverage for cervical cancer screening is an important determinant explaining differences in the incidence of cervical cancer between countries. Offering devices for self-sampling has the potential to increase participation of hard-to-reach women. METHODS A systematic review and meta-analysis were performed to evaluate the participation after an invitation including a self-sampling device (self-sampling arm) versus an invitation to have a sample taken by a health professional (control arm), sent to under-screened women. RESULTS Sixteen randomised studies were found eligible. In an intention-to-treat analysis, the pooled participation in the self-sampling arm was 23.6% (95% confidence interval (CI)=20.2-27.3%), when self-sampling kits were sent by mail to all women, versus 10.3% (95% CI=6.2-15.2%) in the control arm (participation difference: 12.6% [95% CI=9.3-15.9]). When women had to opt-in to receive the self-sampling device, as used in three studies, the pooled participation was not higher in the self-sampling compared to the control arm (participation difference: 0.2% [95% CI=-4.5-4.9%]). CONCLUSION An increased participation was observed in the self-sampling arm compared to the control arm, if self-sampling kits were sent directly to women at their home address. However, the size of the effect varied substantially among studies. Since participation was similar in both arms when women had to opt-in, future studies are warranted to discern opt-in scenarios that are most acceptable to women.
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Affiliation(s)
- F Verdoodt
- Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussels, Belgium
| | - M Jentschke
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany
| | - P Hillemanns
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany
| | - C S Racey
- Dalla Lana School of Public Health, University of Toronto, 155 College Street , 6th Floor, Toronto, Ontario M5T3M7, Canada
| | - P J F Snijders
- Department of Pathology, VU University medical center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - M Arbyn
- Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussels, Belgium.
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