Addressing Taiwan's high incidence of cervical cancer: factors associated with the Nation's low compliance with Papanicolaou screening in Taiwan

The Impact of Psychological Distress on Cervical Cancer

OBJECTIVE

Psychological distress is considered a factor for cancer development. However, the impact of mood disorders (depression and bipolar) on the development of cervical cancer remains uncertain. We conducted a nationwide population-based retrospective cohort study to investigate the association between mood disorders and the subsequent risk of developing cervical cancer.

METHODS

A total of 138,130 participants' profiles between 2000 and 2012 were extracted from the National Health Insurance Research Database and subdivided into a mood-disorder cohort (27,626 participants) and a non-mood-disorder cohort (110,504 participants). Cohorts were propensity-matched for a 1:4 ratio according to age and index year. The Cox proportional hazards regression model was utilized for assessing cervical cancer risk between cohorts.

RESULTS

Kaplan-Meier analysis revealed that the mood-disorder cohort had a higher cumulative incidence of cervical cancer. The mood-disorder cohort was also associated with an increased risk of cervical cancer after adjustments for potential confounders. Subgroup analysis revealed a negative impact of mood disorders on cervical cancer, especially in the 30-50 years and white-collar groups.

CONCLUSIONS

Our findings demonstrated that mood disorders were associated with an increased risk of cervical cancer development, which provide helpful information for clinical strategies to reduce the incidence of cervical cancer in this vulnerable population.

Prevention of gynecological cancers: the affecting factors and knowledge levels of Turkish women

Purpose

Gynecological cancers are preventable and treatable diseases in case of early diagnosis. However, lack of knowledge is one of the factors preventing women from benefiting from early diagnosis. Increasing women's knowledge of gynecological cancers contributes to improving the health of both women and the community. The purpose of this research study was to determine the affecting factors and knowledge level of Turkish women-related gynecological cancer prevention.

Design/methodology/approach

This was a cross-sectional descriptive study and was carried out at a state hospital's outpatient clinic between May and June 2019. The sampling included 496 women who are not diagnosed with gynecological cancer in the individual or in the family. Data were collected using the personal information form and Gynecological Cancer Prevention Information Scale (GCPIS). Data were evaluated using the SPSS 22.0 software program. Frequencies, mean and standard deviation were used for the descriptive variables. For the data that met the parametric conditions, those with two groups were analyzed using independent samplest-tests and those with more than two groups were analyzed usingF-test.

Findings

In this study, the GCPIS total mean score of women was found 16.22 ± 8.21 (min: 0, max: 35). A statistically significant difference was found between the women's level of knowledge according to the age group of the participants, education level, economic status perception, regular pap-smear test, regular vulva examination and getting information about prevention from gynecologic cancers (p < 0.05).

Research limitations/implications

This study was conducted on a group of Turkish women and cannot be generalized to other cultures.

Practical implications

This study can be beneficial for determining the Turkish women's knowledge levels about gynecological cancers of women and for providing data for health education programs planning to be created.

Social implications

The data of this study can be used to improve women's knowledge and examination skills of gynecological cancers. Thus, the quality of life of women can be improved.

Originality/value

Healthcare professionals can play vital roles in presenting needed knowledge about gynecological cancers and raising awareness in women. It is extremely important for women to be informed about gynecological cancers for prevention of gynecological cancers and health improvement.

HEALTH SURVEILLANCE AND PAP TEST COVERAGE: INTEGRATIVE REVIEW

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.

Screening for cervical cancer in women with disability and multimorbidity: a retrospective cohort study in Ontario, Canada

BACKGROUND

People with disability, multiple chronic conditions or both may experience challenges in accessing primary care. We aimed to determine the association between appropriate cervical cancer screening and level of disability among women eligible for screening in Ontario and the influence of relevant sociodemographic and health-related variables, including level of morbidity (measured by number of chronic conditions), on screening.

METHODS

We used multiple linked databases, including 2 waves of the Canadian Community Health Survey (2005 and 2007/08). Of the 22 824 women included in the study, 7600 reported some level of disability. We used Ontario Health Insurance Plan fee codes to identify appropriate cervical cancer screening.

RESULTS

Compared with women without disability, women with disability were older, less educated, had lower income and had more chronic conditions (36.2% had at least 2 conditions v. 8.4% of women without disability). Women with no disability and no chronic conditions were more frequently screened appropriately than those with severe disability and 2 or more chronic conditions (64.5% v. 39.8%). In multivariable logistic regression analysis, age, rurality, education, marital status and household income were each independently associated with cervical cancer screening. There was a significant interaction between level of morbidity and level of disability. Women with a higher level of disability were less likely to be screened than women with lower level of disability as their level of morbidity increased.

CONCLUSION

The rate of screening for cervical cancer is low among women with both disability and multimorbidity. Policymakers should note these results as they work toward improving cancer screening rates for an aging population with complex medical needs.

Cervical screening uptake and its predictors among rural women in Malaysia

INTRODUCTION

Cervical cancer is the third most common cancer among Malaysian women. However, the uptake of cervical cancer screening--Pap smear--by women in Malaysia has been low and remains a challenge. This study was conducted to assess the cervical screening practices of rural women in Malaysia and to examine the factors associated with such practices.

METHODS

A cross-sectional survey was conducted in five rural districts in Perak, Malaysia. 1,000 households were selected through multistage random sampling. Women aged 20-64 years were interviewed by trained enumerators using structured questionnaires. Binomial logistic regression was used to identify predictors of cervical screening through univariate and multivariate analyses.

RESULTS

Among the 959 respondents, only 48.9% had undergone Pap smear at least once in the past three years. Women in the age group 40-49 years (odds ratio 3.027, 95% confidence interval 1.546-5.925; p < 0.005) were found to be significantly more likely to attend cervical cancer screening as compared to those in the age group 20-29 years. Other significant predictors were being married with children, having knowledge of cervical cancer symptoms, receiving relevant information regarding cervical cancer from health personnel or campaigns, being engaged in family planning and receiving encouragement from husbands.

CONCLUSION

Efforts to boost the uptake of Pap smear screening among the rural population should be targeted toward the predictors of positive uptake.

Quality of life, treatments, and patients' willingness to pay for a complete remission of cervical cancer in Taiwan

Cervical cancer is one of the leading causes of cancer deaths in Taiwan. To investigate the disease cost and then raise awareness of the importance of screening for cervical cancer and promote early detection, this paper employs contingent valuation and willingness to pay (WTP) method to study how health-related quality of life, disease severity, and after-treatment disease status affect patients' WTP for a complete remission of the disease. The inclusive criteria for the study were primary case outpatients at least 3 months after they had received therapy at the time of our study period. Face-to-face interviews were conducted for the retrospective format of the survey. The result of the study indicates a lifetime WTP of $US21 221.96 for Taiwanese cervical cancer patients, which is significantly higher than the cost of screening for early detection. Disease stages do not show a consistent pattern in influencing WTP, but patients with surgery are willing to pay a significantly higher amount for a complete remission from the disease than patients without. In addition, mental health, positive attitudes toward life, and quality of life also are key factors that influence WTP.

Factors associated with the use of uterine cervical cancer screening services in korean elderly women

Background

The Papanicolaou (Pap) smear test is an effective screening test for the early detection of uterine cervical cancer. The Pap test still plays an important role in Korean elderly women, as uterine cervical cancer remains a frequent form of cancer and an important cause of death. However, the participation rate and other factors related to the Pap test in Korean elderly women have been studied insufficiently.

Methods

This study included 654 individuals aged 65 and over who completed a cervical cancer screening questionnaire from the Third Korean National Health and Nutrition Examination Survey 2005. Using multiple logistic regression, odds ratios and confidence intervals for the association between attendance of the Pap test and sociodemographic or health-related factors were calculated.

Results

One hundred and eleven individuals (17.0%) of the study population showed compliance with Pap testing within the previous 2 years. We recognized that the most elderly women (75 years and over) or those with lower levels of education were less likely to have had the test.

Conclusion

Primary health care providers need to make efforts to improve attendance rates of Pap smear screening in Korean elderly women, individually taking into account previous Pap results, life expectancy, risk factors for cervical cancer, and preferences. More attention will especially be needed among the eldest elderly or less educated elderly women.

Knowledge and attitudes regarding cervical cancer screening among women with physical disabilities living in the community

The study aims to explore knowledge and attitudes regarding cervical cancer screening and to examine its determinants based on the perspectives of Taiwanese women with physical disabilities living in the community. A cross-sectional survey was employed in the study, and we recruited 498 women aged more than 15 years who were officially registered as having physical disabilities in Taipei County, Taiwan, in March 2009. A mail-out structured questionnaire designed to collect data concerning the participants' demographics, reported use, health experience and perception (understanding and attitudes) of cervical cancer screening among women with physical disabilities. We used a scoring system (range 0-10) to categorize the study subjects' awareness of screening (low vs. high). The results showed that 77.3% of subjects reported a low level of awareness (score < [double bond] 7), whereas 22.7% were in the high awareness level group (score > 7). The logistic regression model revealed that married women (OR = 3.30, 95%CI = 1.25-8.71), those with a higher educational level (OR = 2.88, 95%CI=1.51-5.53), and those with a high familiarity with Pap smear resources (OR = 5.31, 95%CI = 2.82-9.98) had a significantly higher perception level of cervical cancer screening among women with physical disabilities. This study highlights the necessity of increasing the knowledge and awareness of cervical cancer screening and reducing the barriers to cervical cancer screening experienced by women with disabilities.

Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: three public policy implications

Background

Cervical cancer is an important public health problem worldwide, which comprises approximately 12% of all cancers in women. In Tanzania, the estimated incidence rate is 30 to 40 per 100,000 women, indicating a high disease burden. Cervical cancer screening is acknowledged as currently the most effective approach for cervical cancer control, and it is associated with reduced incidence and mortality from the disease. The aim of the study was to identify the most important factors related to the uptake of cervical cancer screening among women in a rural district of Tanzania.

Methods

A cross sectional study was conducted with a sample of 354 women aged 18 to 69 years residing in Moshi Rural District. A multistage sampling technique was used to randomly select eligible women. A one-hour interview was conducted with each woman in her home. The 17 questions were modified from similar questions used in previous research.

Results

Less than one quarter (22.6%) of the participants had obtained cervical cancer screening. The following characteristics, when examined separately in relation to the uptake of cervical cancer screening service, were significant: husband approval of cervical cancer screening, women's level of education, women's knowledge of cervical cancer and its prevention, women's concerns about embarrassment and pain of screening, women's preference for the sex of health provider, and women's awareness of and distance to cervical cancer screening services. When examined simultaneously in a logistic regression, we found that only knowledge of cervical cancer and its prevention (OR = 8.90, 95%CI = 2.14-16.03) and distance to the facility which provides cervical cancer screening (OR = 3.98, 95%CI = 0.18-5.10) were significantly associated with screening uptake.

Conclusions

Based on the study findings, three recommendations are made. First, information about cervical cancer must be presented to women. Second, public education of the disease must include specific information on how to prevent it as well as screening services available. Third, it is important to provide cervical cancer screening services within 5 km of where women reside.

Self-reports of Pap smear screening in women with physical disabilities

We collected self reported rate of cervical smear testing and to examine the affecting factors in women with physical disabilities in the study, to define the reproductive health care for this group of people. The study population recruited 521 women with physical disabilities aged more than 15 years who were officially registered as having physical disabilities in Taipei County, Taiwan. Those people with physical disabilities include following: upper and low limb, spinal cord injury and other nervous system impairments. Results found that there were 71.5% participants had ever used the Pap smear tests in their life time and mean age of the first screening was 39.21±10.16 years (range=20-85 years). Nearly 41% of participants expressed that they had accepted the screening within 1 year and 28.1% reported they used the Pap smear screening regularly. Our study also found women with physical disabilities have higher use of Pap smear tests than does the general population in Taiwan (74% vs. 64% in aged≥30 years). Logistic regression model for the use of Pap smear test indicated that those married women (OR=12.06, 95% CI=6.85-21.22), with mild level of disability (OR=2.10, 95% CI=1.05-4.21) and high cognitive level toward Pap smear information were factors to affect the use of Pap smear in the study participants. We suggest the further study should conduct to examine the quality perception and follow-up service of Pap smear test for women with physical disabilities, to ensure the health care right for this group of women.

Papanicolaou screening in Taiwan: perceived barriers and self-efficacy

Cervical cancer remains a leading cause of death in Taiwan, and frequency of screening remains low. We surveyed Taiwanese women about beliefs and practices related to cervical screening, searching for perceived barriers and self-efficacy using the transtheoretical model. We assessed demographics, 12 perceived barriers, and seven self-efficacy measures for 222 Taiwanese women. Data were analyzed descriptively and with multiple linear regression. Barriers related to worry, embarrassment, stigma, and the lack of female physicians were significant in the relapse stage. All self-efficacy measures were significant across various stages of change. Interventions should focus on relapsers and on information related to self-efficacy.

Barriers to colorectal cancer screening: A case-control study

AIM: To investigate barriers to colorectal cancer (CRC) screening in a community population.

METHODS: We conducted a community-based case-control study in an urban Chinese population by questionnaire. Cases were selected from those completing both a fecal occult blood test (FOBT) case and colonoscopy in a CRC screening program in 2004. Control groups were matched by gender, age group and community. Control 1 included those having a positive FOBT but refusing a colonoscopy. Control 2 included those who refused both an FOBT and colonoscopy.

RESULTS: The impact of occupation on willingness to attend a colorectal screening program differed by gender. P for heterogeneity was 0.009 for case vs control group 1, 0.01 for case versus control group 2, and 0.80 for control group 1 vs 2. Poor awareness of CRC and its screening program, characteristics of screening tests, and lack of time affected the screening rate. Financial support, fear of pain and bowel preparation were barriers to a colonoscopy as a screening test. Eighty-two percent of control group 1 and 87.1% of control group 2 were willing attend if the colonoscopy was free, but only 56.3% and 53.1%, respectively, if it was self-paid. Multivariate odds ratios for case vs control group 1 were 0.10 among those unwilling to attend a free colonoscopy and 0.50 among those unwilling to attend a self-paid colonoscopy.

CONCLUSION: Raising the public awareness of CRC and its screening, integrating CRC screening into the health care system, and using a painless colonoscopy would increase its screening rate.

Estimating the Long-Term Clinical Impact of Cervical Cancer Vaccination in Taiwan

The high burden of human papillomavirus (HPV) infection and subsequent cervical cancer in the presence of screening in Taiwan suggests the need for further prevention strategies. Epidemiology and screening practices vary considerably between countries, and specific analyses are required to estimate the impact of HPV vaccination. This study adapted a computer-based health economic model to Taiwan to project the clinical impact of the introduction of a prophylactic vaccine against persistent HPV 16/18 infection on cervical disease. A Markov model based on the natural history of HPV and cervical cancer was developed to simulate transitions between health states (normal, HPV, cervical intraepithelial neoplasia [CIN] stages I to III, cervical cancer stages I to IV, and death) in the presence of screening. The model was calibrated to Taiwan epidemiological end points including age-specific HPV prevalence, prevalence of CIN lesions, and predicted cervical cancer incidence and mortality. Taiwanese screening and treatment practices were modeled, and published clinical trial data were used to estimate vaccine efficacy. With 100% vaccine coverage in a 13-year-old cohort of females, there is estimated to be a 71% reduction in cervical cancer cases and deaths due to all HPV types and substantial reductions in the prevalence of precancerous lesions and screening outcomes. Removing the risk of HPV infection of a large proportion of Taiwanese females, with a high underlying cervical cancer incidence rate, would be expected to have dramatic effects on the health care system and mortality in Taiwan.