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Baruch L, Bilitzky-Kopit A, Rosen K, Adler L. Cervical Cancer Screening Among Patients with Physical Disability. J Womens Health (Larchmt) 2022; 31:1173-1178. [PMID: 35072543 PMCID: PMC9419959 DOI: 10.1089/jwh.2021.0447] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Pap smear has a central role in cervical cancer screening. Previous studies have found that female patients with disabilities are less likely to receive a Pap smear as recommended by guidelines. The aim of our study was to examine the association between physical disability and Pap smear receipt in Israel. Methods: This cross-sectional study was conducted using the electronic medical records of the second largest health care maintenance organization in Israel. All female patients during 2012–2017 aged 25–65 were identified. The exposure variable was physical disability, and the outcome variable was Pap smear receipt. We used logistic regression to control for covariates. Results: A total of 391,259 patients were eligible for this study, 6,720 (1.7%) with physical disability. 56.7% of patients with disabilities had received Pap smear compared to 63.3% of patients without disabilities, odds ratio (OR) 0.76, 95% confidence interval [CI] 0.72–0.80. When adjusting to sociodemographic and clinical covariates, patients with disabilities were less likely to receive Pap smear, adjusted OR 0.83, 95% CI 0.79–0.88. For all patients, older age, lower socioeconomic status, religious minorities, cardiovascular disease, type-2 diabetes mellitus, hypertension, smoking, and obesity were associated with lower odds of receipt of Pap smear. A history of nongynecologic oncologic disease was associated with increased odds of Pap smear receipt. Conclusion: Our study highlights the disparities between patients with and without physical disability with regard to screening for cervical cancer by receipt of Pap smear. Creating an appropriate practice with adequate access to patients with disability should be a focus for health care providers and policy makers.
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Affiliation(s)
- Lior Baruch
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Lior Baruch, MD, Founder of HealthyHer-Feminist Medicine, integrating intersectional feminism in medical practice. A resident in the department of family medicine in Maccabi Healthcare Services, Tel Aviv University, Tel Aviv, Israel. Interested in women's and LGBTQI+ health and in reducing health disparities
| | - Avital Bilitzky-Kopit
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Avital Bilitzky-Kopit, MD, MPH, A resident in the department of family medicine in Maccabi Healthcare Services, Tel Aviv University, Tel Aviv, Israel. Interested in nutrition interventions and public health
| | - Keren Rosen
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Keren Rosen, MD, A resident in the department of family medicine in Maccabi Healthcare Services, Tel Aviv University, Tel Aviv, Israel. Interested in immunology, preventive medicine, and women's health
| | - Limor Adler
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Limor Adler, MD, A specialist in Family Medicine in the Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Works as a family physician in Maccabi Health care Services. Interested in community health research, addiction medicine, and women's health
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Chodick G, Teper GR, Levi S, Kopel H, Kleinbort A, Khen E, Schejter E, Shalev V, Stein M, Lewis N. The impact of a Facebook campaign among mothers on HPV vaccine uptake among their daughters: A randomized field study. Gynecol Oncol 2020; 160:106-111. [PMID: 33162176 DOI: 10.1016/j.ygyno.2020.10.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The popularity of social networks provide an incredible opportunity to enhance the impact of preventive medicine programs. We aimed to assess whether a targeted Facebook campaign among mothers may increase the uptake of human Papilloma virus (HPV) immunization among their 8th-grade daughters. METHODS This field study was conducted among the members of a state-mandated health organization in Israel. Included were all 21,592 members who were mothers to 14 year-old daughters in the 2018-19 school-year. A total of 17,271 (80%) were randomly allocated to the campaign arm and the rest (n=4,321) were selected as a reference group. The Facebook ads addressed issues and concerns regarding HPV-related diseases and HPV vaccine. Main outcome measures were Facebook metrics on exposure to campaign and HPV immunization among eighth grade daughters of the study participants. RESULTS Between 8/2018-10/2018, Facebook ads were shown 1.8-million times (a reach of 88%). The uptake of HPV vaccine among daughters of women allocated to the campaign arm (55.3%) was similar (p = 0.749) to 55.0% in the control group. The only significant differences between study groups were observed when stratifying by SES level. In the lowest SES quartile, Facebook campaign significantly (p = .02) reduced vaccine uptake (35% vs. 39.0%), with a relative risk of 0.90 (95%CI: 0.82-0.98), while in the second SES quartile, Facebook campaign increased vaccine uptake from 52.6% to 55.8%, with a RR of 1.06 (95%CI,1.00-1.12). Among mothers in higher SES levels, daughters of exposed and unexposed mothers had similar immunization rates. CONCLUSIONS Facebook campaign may increase the uptake of HPV vaccine among daughters to mothers of medium-to-low SES level, but it may reduce vaccination among lower SES groups.
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Affiliation(s)
- Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
| | | | | | | | | | | | - Eduardo Schejter
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Varda Shalev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Michal Stein
- Infectious diseases and infection control unit, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport faculty of medicine, Technion institute, Israel
| | - Nehama Lewis
- Department of Communication, Haifa University, Haifa, Israel
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Raz Y, Keinan-Boker L, Goren S, Soen-Grisaru G, Cohen D, Grisaru D. The effect of age at immigration on cervical cancer incidence: a population-based cohort study of 1 486 438 Israeli women. Int J Gynecol Cancer 2019; 29:492-496. [PMID: 30833437 DOI: 10.1136/ijgc-2018-000053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To clarify the effect of mass migration from a high-risk area (former Soviet Union) to a low-risk area (Israel) on cervical cancer incidence and mortality in Israel and the modifying effect of age at immigration. METHODS All women who immigrated to Israel from the former Soviet Union between January 1, 1990 and December 31, 2000 (N=345 202) and all Jewish Israeli-born women who were 0-80 years old on January 1, 1990 (N=1 141 236) were included. Follow-up ended at December 31, 2010 or date of death or date of cervical cancer diagnosis, whatever occurred earlier. Crossing data from the computerized population registry of the Ministry of Interior, the Israel National Cancer Registry and the Central Bureau of Statistics, cervical cancer incidence and mortality and adjusted hazard ratios (aHR) with 95% confidence intervals (95% CI) were calculated. RESULTS 1595 new cases (crude incidence rate 29.71: 100 000 person years) of cervical cancer were diagnosed in immigrants as compared with 6159 cases (crude incidence rate 27.21: 100 000 person years) diagnosed in Israel-born Jewish women. Immigration at an age older than 12 years was hazardous (aHR 1.27, 95% CI 1.19 to 1.35; P<0.001) while immigration at a younger age was protective (aHR 0.62, 95% CI 0.51 to 0.75; P<0.001) for cervical cancer incidence compared with native Israeli women. Cervical cancer mortality was also significantly higher in immigrants compared with Israel-born women with incidence density rates of 1.15 and 0.35 per 100 person years, respectively (P<0.0001). CONCLUSIONS Factors related to the acquired causes of the disease at the country of origin are probably at the root of the low incidence of cervical cancer in Israel. Adult immigrants from the former Soviet Union should be managed as a high-risk group.
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Affiliation(s)
- Yael Raz
- 'Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Gertner Institute, Sheba Medical Center, Ramat Gan, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Sophy Goren
- Stanley Steyer Institute for Cancer Epidemiology and Research, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Soen-Grisaru
- Pediatrics Infectious Diseases Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Daniel Cohen
- Stanley Steyer Institute for Cancer Epidemiology and Research, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Grisaru
- 'Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Zhao J, Li Y, Zhang Q, Wang Y. Does ovarian stimulation for IVF increase gynaecological cancer risk? A systematic review and meta-analysis. Reprod Biomed Online 2015; 31:20-9. [PMID: 26003452 DOI: 10.1016/j.rbmo.2015.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 12/12/2022]
Abstract
The aim of this study was to evaluate whether ovarian stimulation for IVF increases the risk of gynaecological cancer, including ovarian, endometrial, cervical and breast cancers, as an independent risk factor. A systematic review and meta-analysis was conducted. Clinical trials that examined the association between ovarian stimulation for IVF and gynaecologic cancers were included. The outcomes of interest were incidence rate of gynaecologic cancers. Twelve cohort studies with 178,396 women exposed to IVF were included; 10 studies were used to analyse ovarian (167,640 women) and breast (151,702 women) cancers, and six studies were identified in the analysis of endometrial (116,672 women) and cervical cancer (114,799 women). Among these studies, 175 ovarian, 48 endometrial, 502 cervical and 866 cases of breast cancer were reported. The meta-analysis found no significant association between ovarian stimulation for IVF and increased ovarian, endometrial, cervical and breast cancer risk (odds ratio [OR] 1.06, 95% confidence interval [CI] 0.85 to 1.32; OR 0.97, 95% CI 0.58 to 1.63; OR 0.43, 95% CI 0.30 to 0.60; OR 0.69, 95% CI 0.63 to 0.76, respectively). Ovarian stimulation for IVF, therefore, does not increase the gynaecologic cancer risk, whether hormone-dependent endometrial and breast cancer or non-hormone-dependent ovarian and cervical cancer.
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Affiliation(s)
- Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Qiong Zhang
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yonggang Wang
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Schejter E, Bornstein J, Siegler E. Cervical cancer screening, human papillomavirus vaccination practices and current infrastructure in Israel. Vaccine 2014; 31 Suppl 8:I42-5. [PMID: 24229718 DOI: 10.1016/j.vaccine.2012.06.099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/28/2012] [Accepted: 06/13/2012] [Indexed: 11/17/2022]
Abstract
The incidence rates for premalignant lesions in Jewish women in Israel are similar to those observed in Western countries, but the incidence of cervical cancer in Israel is low; this discrepancy is not yet clearly understood. Because of the low incidence of cervical cancer in Israel, it was decided to base cervical cancer prevention on opportunistic screening: every woman from the ages of 35-54 years can have a Pap test smear free of charge every 3 years. Over the last decade 12.2% of the women population had an annual Pap test. From 36 to 50% of women who attended the Clalit Health Maintenance Organization (HMO) and the Maccabi HMO, the two largest HMOs in Israel, did so. There were also discrepancies between women of different socio-economic status (SES): <10% in the lowest SES level were screened compared to almost 55% in the higher level. HPV vaccination was opportunistic but it will be introduced to the school-based vaccine program at age of 13 years old as of September 2013. The Israel Society of Obstetrics and Gynecology recommends continuing cytologic screening in vaccinated women as recommended for the general population. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in Israel" Vaccine Volume 31, Supplement 8, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Affiliation(s)
- Eduardo Schejter
- Women's Health Center, Maccabi Healthcare Services, Tel Aviv, Israel.
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Shavit O, Roura E, Barchana M, Diaz M, Bornstein J. Burden of human papillomavirus infection and related diseases in Israel. Vaccine 2014; 31 Suppl 8:I32-41. [PMID: 24229717 DOI: 10.1016/j.vaccine.2013.05.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/16/2012] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
This manuscript provides the available data on the burden of human papillomavirus (HPV) infections and HPV-related diseases in Israel. The incidence of cervical intraepithelial neoplasia grade 3 (CIN3) among Jewish women was 17.4 per 100,000 in 2007, showing an increase since 1997. The incidence of cervical cancer was 5.3 per 100,000 Israeli Jewish women and 2.3 per 100,000 Israeli non-Jewish women in 2007. This rate is relatively low compared to other developed countries, and could be explained by cultural and religious factors such as male circumcision or sexual behavior. Mortality rates were around 1.5 per 100,000 Israeli women in 2007. Incidences of other anogenital, oral cavity, and pharynx cancers are very low, below 1.0 per 100.000 Israeli women and men. Information is scarce on HPV prevalence and HPV type distribution among women with cervical cancer. HPV types 16 and 18 were the two most common types in both preneoplastic lesions and cervical cancer, representing 60% of total invasive cases. Data on genital warts show an incidence rate of 239 per 100,000 men and 185 per 100,000 women, similar to that found in other Western countries. Despite these low incidences, it is important to improve the information on the overall burden of HPV-related morbidity and on the HPV prevalence to evaluate an organized cervical cancer screening program and the introduction of the HPV vaccine in the national school-based vaccine program. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in Israel" Vaccine Volume 31, Supplement 8, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Affiliation(s)
- Oren Shavit
- Division of Clinical Pharmacy, The School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel; Health Technology Assessment, MSD-Israel, Hod Hasharon, Israel.
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Bassal R, Schejter E, Bachar R, Shapira H, Sandbank J, Supino Rosin L, Schvimer M, Cohen D, Keinan-Boker L. Cervical Pap screening among Israeli women, 2005-2010. Arch Gynecol Obstet 2013; 289:615-22. [PMID: 24085583 DOI: 10.1007/s00404-013-3045-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study describes the distribution and the trends of cervical abnormalities in Israel, based on Pap smear results. METHODS A retrospective analysis of cervical smears received by the Central Pathology Laboratory of Maccabi Healthcare Services between January 2005 and December 2010. RESULTS In total, 711,541 Pap smears were screened in the study period. Cytological abnormalities were observed in 4.78% of the total smears screened. An increase was observed in the rate of positive results from 2.63% in 2005 to 6.78% in 2010 (p = 0.0026). The cervical abnormalities in the study period distributed as follows: atypical squamous cell (ASC)-2.72%, low-grade squamous intraepithelial lesion (LSIL)-1.54%, high-grade squamous intraepithelial lesion (HSIL)-0.34%, squamous cell carcinoma-0.01%, atypical glandular cells (AGC)-0.10%, adenocarcinoma in situ (AIS)-0.06% and invasive adenocarcinoma-0.01%. The increase was statistically significant for ASC (p = 0.0028), LSIL (p = 0.0069) and for HSIL (p = 0.0260). The mean ages at diagnosis of women with ASCUS, LSIL, HSIL, squamous cell carcinoma, AGC, AIS and adenocarcinoma were 37.8, 33.2, 38.6, 55.4, 41.1, 49.9 and 57.1 years, respectively. CONCLUSIONS The increase in the rate of squamous cell abnormalities demonstrated in this study emphasizes the need of implementing an education and a screening program among Israeli women. HPV vaccine, sexual behavior, cytology performance and HPV test are primary and secondary prevention tools which may reduce morbidity and mortality in the future. In addition, based on the age at diagnosis of the different pathologies, the age group in which Pap test is performed in Israel should be expanded from 35-54 to 25-65 years.
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Affiliation(s)
- Ravit Bassal
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel,
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Brinton LA, Trabert B, Shalev V, Lunenfeld E, Sella T, Chodick G. In vitro fertilization and risk of breast and gynecologic cancers: a retrospective cohort study within the Israeli Maccabi Healthcare Services. Fertil Steril 2013; 99:1189-96. [PMID: 23375197 DOI: 10.1016/j.fertnstert.2012.12.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 11/29/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess long-term cancer risks associated with in vitro fertilization (IVF). DESIGN Record-linkage study. SETTING Health maintenance organization in Israel. PATIENT(S) A total of 87,403 women evaluated and/or treated for infertility on or after September 25, 1994, who were followed for cancer development through June 22, 2011: 522 breast, 41 endometrial, 45 ovarian, 311 in situ cervical, and 32 invasive cervical cancers were identified. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Hazard ratios (HRs) for specific cancers. RESULT(S) We found no significant relationships of IVF exposures to the risks of breast, endometrial, or ovarian cancers. However, compared with women with no fertility treatment, the HR for ovarian cancer associated with IVF was 1.58 (95% confidence interval [CI] 0.75-3.29), with higher risk among those receiving four or more cycles (HR 1.78, 95% CI 0.76-4.13). There was also a nonsignificantly elevated risk for endometrial cancer among women who received 1-3 IVF cycles (HR 1.94, 95% CI 0.73-5.12), but additional cycles were associated with less risk. In contrast, the risk of in situ cervical cancer was significantly reduced and invasive cervical cancer nonsignificantly reduced among women receiving IVF as well as other fertility treatments. CONCLUSION(S) Our results regarding long-term effects were largely reassuring, but women receiving IVF should continue to be monitored given that the procedures involve potent ovulation stimulators and repeated ovarian punctures.
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Affiliation(s)
- Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852, USA.
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