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Lyonnais E, Vigoureux S, Blondel B, Wylomanski S, Azria E. Women's country of birth and failure to catch up an overdue cervical cancer cytological screening participation during pregnancy in France, an observational study based on survey sources. BMC Cancer 2024; 24:595. [PMID: 38750453 PMCID: PMC11097417 DOI: 10.1186/s12885-024-12335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide, both for incidence and mortality. Prevention relies on screening with a Pap test to detect precancerous lesions, which can then be treated. Access to this screening is currently both improvable and inequitable. Pregnancy may be an ideal moment for women to catch up on their overdue cervical cancer screening. In the general population, women's risk of not being screened is associated with their place of birth and other social factors; this may be true as well among pregnant women. Our objective was to study the association between women's place of birth and their failure to catch up with this screening during pregnancy. METHODS The 2016 French National Perinatal Survey included 13,147 women who gave birth after 21 weeks of gestation. The association between their place of birth and failure to catch up on this screening (defined by the absence of a Pap test during pregnancy for women overdue for it) was adjusted for age, parity, education level, health insurance, and when they began prenatal care with logistic regression models. RESULTS Among the women for whom screening was then recommended, 49% were not up to date at the start of pregnancy, and of these, 53% were not caught up before delivery. After adjustment for other risk factors, maternal place of birth was not associated with a higher risk of failure to catch up with this screening during pregnancy. However, factors identified as associated with this risk included a low education level and late start of prenatal care. CONCLUSION About half of women overdue for cervical cancer screening did not catch up with it during their pregnancy. Professionals should pay special attention to women with lower education levels and late initiation of prenatal care, who constitute a group at high risk of not catching up on this screening during pregnancy.
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Affiliation(s)
- Elisabeth Lyonnais
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé Research Team), FHU Prema, Université Paris Cité - INSERM, 75014, Paris, France.
| | - Solène Vigoureux
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé Research Team), FHU Prema, Université Paris Cité - INSERM, 75014, Paris, France
| | - Béatrice Blondel
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé Research Team), FHU Prema, Université Paris Cité - INSERM, 75014, Paris, France
| | | | - Elie Azria
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé Research Team), FHU Prema, Université Paris Cité - INSERM, 75014, Paris, France
- Maternity Unit, Paris Saint Joseph Hospital, Paris, France
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Seoud M, Jaafar I, Hamadeh R, Ammar W, Atallah D, El-Kak F. Feasibility of implementing cytology-based cervical cancer screening national program in Lebanon: A pilot study. Int J Gynaecol Obstet 2023; 161:86-92. [PMID: 36183305 DOI: 10.1002/ijgo.14489] [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: 01/12/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review our national cervical cancer screening program using existing Ministry of Public Health primary healthcare centers (PHCs) and report the impact of women's knowledge, attitude, behavior, and practices on screening uptake and outcome. METHODS A cross-sectional study on cervical cancer screening offered to sexually active Lebanese women aged 21 years and above visiting PHCs. Exclusions were history of complete hysterectomy, gynecologic cancers, and current pregnancy. Data were collected through a questionnaire and conventional cervical smear performed by trained healthcare providers and sent to one centralized cytopathology laboratory. RESULTS Of 12 273 eligible women, 1.7% had an abnormal cervical smear test including 161 atypical squamous cells (ASC) of undetermined significance, 6 atypical glandular cells of undetermined significance, 16 low-grade squamous intraepithelial lesion (SIL), 17 ASC-cannot rule out high-grade SIL, 11 high-grade SIL, and one invasive carcinoma. Knowledge and attitudes significantly affected participation in screening; women lacking awareness had rarely undergone a cervical smear. CONCLUSION In Lebanon, cytology-based cervical cancer screening is feasible within the PHCs. Positive screen incidence was low. Despite previous campaigns, a low level of knowledge persists, and affects women's com with the screening guidelines. Advocacy and awareness activities by key healthcare providers may help to improve participation.
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Affiliation(s)
- Muhieddine Seoud
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.,Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Iman Jaafar
- Epidemiology Department, Cancer Center, Scientific Institute of Public Health, Brussels, Belgium
| | | | | | - David Atallah
- Department of Obstetrics and Gynecology, Hotel Dieu de France, Beirut, Lebanon
| | - Faysal El-Kak
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Suurna M, Orumaa M, Ringmets I, Pärna K. Inequalities in reported use of cervical screening in Estonia: results from cross-sectional studies in 2004-2020. BMC Womens Health 2022; 22:545. [PMID: 36566176 PMCID: PMC9789641 DOI: 10.1186/s12905-022-02123-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite the national cervical cancer (CC) screening program established in 2006, the CC incidence in Estonia in 2020 was still one of the highest in Europe. To better understand the possible barriers among women, the aim of this study was to describe the inequalities in the Pap smear uptake trend in 2004-2020 and to analyse the associations between different factors in Estonia. METHODS Weighted data of 25-64-year-old women (N = 6685) from population-based cross-sectional studies of Health Behaviour among Estonian Adult Population in 2004-2020 was used. Linear trends in uptake of Pap smear over time were tested using the Cochrane-Armitage test. Binary logistic regression with interactions was performed to analyse associations between the uptake of Pap smear and sociodemographic, socioeconomic, health-related and lifestyle factors. Crude and adjusted odds ratios with 95% confidence intervals were calculated. RESULTS Prevalence of lifetime uptake of Pap smear increased in 2004-2020 from 50.6 to 86.7% (P < 0.001). From 2004 to 2020, uptake of Pap smear increased significantly among women aged 25-34, 35-44, 45-54 and 55-64, in both ethnicity groups and among women with basic, secondary and higher education (P < 0.001). The gap in Pap smear uptake increased between Estonians and non-Estonians but decreased between education levels over time. Lower lifetime uptake of Pap smear was associated from sociodemographic factors with younger age, being non-Estonian and single, from socioeconomic factors with lower educational level and unemployment, from health indicators with higher body mass index indicating overweight and obesity, presence of chronic disease and depressiveness, and from lifestyle factors with non-smoking. CONCLUSIONS Although Pap smear uptake among 25-64 year old women increased significantly in Estonia in 2004-2020, inequalities were found indicating an opportunity for development of targeted CC prevention strategies.
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Affiliation(s)
- Maria Suurna
- grid.416712.70000 0001 0806 1156Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Madleen Orumaa
- grid.416712.70000 0001 0806 1156Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia ,grid.418941.10000 0001 0727 140XDepartment of Research, Cancer Registry of Norway, Oslo, Norway
| | - Inge Ringmets
- grid.10939.320000 0001 0943 7661Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
| | - Kersti Pärna
- grid.10939.320000 0001 0943 7661Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
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Liu Y, Guo J, Zhu G, Zhang B, Feng XL. Changes in rate and socioeconomic inequality of cervical cancer screening in northeastern China from 2013 to 2018. Front Med (Lausanne) 2022; 9:913361. [PMID: 36275788 PMCID: PMC9580066 DOI: 10.3389/fmed.2022.913361] [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] [Received: 04/05/2022] [Accepted: 08/16/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Cervical cancer, the fourth leading cancer diagnosed in women, has brought great attention to cervical cancer screening to eliminate cervical cancer. In this study, we analyzed two waves of provincially representative data from northeastern China's National Health Services Survey (NHSS) in 2013 and 2018, to investigate the temporal changes and socioeconomic inequalities in the cervical cancer screening rate in northeastern China. Methods Data from two waves (2013 and 2018) of the NHSS deployed in Jilin Province were analyzed. We included women aged 15-64 years old and considered the occurrence of any cervical screening in the past 12 months to measure the cervical cancer screening rate in correlation with the annual per-capita household income, educational attainment, health insurance, and other socioeconomic characteristics. Results A total of 11,616 women aged 15-64 years were eligible for inclusion. Among all participants, 7,069 participants (61.11%) were from rural areas. The rate of cervical cancer screening increased from 2013 to 2018 [odds ratio (OR): 1.06; 95% confidence interval (CI): 1.04-1.09, p < 0.001]. In total, the cervical cancer screening rate was higher among participants who lived in urban areas than rural areas (OR: 1.20; 95% CI: 1.03-1.39, p = 0.020). The rate was also higher among those with the highest household income per capita (OR: 1.30; 95% CI: 1.07-1.56, p = 0.007), with higher educational attainment (p < 0.001), and with health insurance (p < 0.05), respectively. The rate of cervical cancer screening was also significantly associated with parity (OR: 1.62; 95% CI: 1.23-2.41, p = 0.001) and marital status (OR: 1.45; 95% CI: 1.15-1.81, p = 0.001) but not ethnicity (OR: 1.41; 95% CI: 0.95-1.36, p = 0.164). Conclusion Cervical cancer screening coverage improved from 2013 to 2018 in northeastern China but remains far below the target 70% screening rate proposed by the World Health Organization. Although rural-urban inequality disappeared over time, other socioeconomic inequalities remained.
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Affiliation(s)
- Yaqian Liu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Guangyu Zhu
- Department of Computer Science and Statistics, University of Rhode Island, Kingston, RI, United States
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States,*Correspondence: Bo Zhang
| | - Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China,Xing Lin Feng
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Women with obesity participate less in cervical cancer screening and are more likely to have unsatisfactory smears: Results from a nationwide Danish cohort study. Prev Med 2022; 159:107072. [PMID: 35460722 DOI: 10.1016/j.ypmed.2022.107072] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022]
Abstract
Some studies found an association between obesity and increased cervical cancer risk, but potential mechanisms are unknown. In this nationwide register-based cohort study, we investigated the association between overweight/obesity and cervical cancer screening participation and risk of unsatisfactory smears. The study population was identified in the Danish Medical Birth Registry. We included 342,526 women aged 23-49 years with pre-pregnancy body mass index (BMI) registered during 2004-2013. Screening participation and unsatisfactory smears during up to four years after child birth were identified in a nationwide pathology register. We used absolute risk regression to estimate the relative absolute risk (RAR) with 95% confidence intervals (CIs) of screening participation according to BMI, adjusted for age, calendar year, sociodemographic characteristics, parity and previous high-grade cervical intraepithelial neoplasia. Among those who were screened (n = 295,482), we used log-binomial regression to investigate the relative risk (RR) of an unsatisfactory smear according to BMI, adjusted for age, year, parity, oral contraceptive use and pathology department. A lower proportion of obese women (79.3%) than women of normal weight (85.8%) were screened, and obese women had lower adjusted probability of being screened than women of normal weight (RARadjusted = 0.94, 95% CI, 0.93-0.95). A higher proportion of obese women (2.4%) than women of normal weight (1.7%) had an unsatisfactory smear, and this association remained after adjustments (RRadjusted = 1.28, 95% CI, 1.19-1.38). In conclusion, women with obesity were less likely to participate in cervical cancer screening and more likely to have an unsatisfactory smear than women of normal weight.
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Trends and Determinants in Uptake of Cervical Cancer Screening in Spain: An Analysis of National Surveys from 2017 and 2020. Cancers (Basel) 2022; 14:cancers14102481. [PMID: 35626086 PMCID: PMC9140061 DOI: 10.3390/cancers14102481] [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] [Received: 04/18/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/22/2022] Open
Abstract
Cervical cancer rates have declined in industrialized nations as a result of cytology screening programs. However, there are still sizeable differences in screening adherence in Spain. This study aimed to identify the prevalence of cervical cancer screening among women in Spain, to analyze trends in that prevalence from 2017 and 2020 and to identify socio-demographic, health, and lifestyle factors related with adherence to this screening test. We conducted a cross-sectional study of 13,619 women aged 25−65 who participated in the 2017 Spanish National Health Survey and the 2020 European Health Survey for Spain. We used logistic regression to examine the relationship between socio-demographic, health and lifestyle factors and cervical cancer adherence. The prevalence of adherence was 73.18%. Additionally, there was a significant decrease in cervical cancer screening uptake from 2017 and 2020 among women aged 25−44 years (2017: 77.80%, 2020: 75.20%, p = 0.02), but an increase in the age group of 45−65 years (2017: 68.93%, 2020: 72.39%, p < 0.01) and in foreigners (2017: 64.29%, 2020: 72.29%, p < 0.01). Screening for cervical cancer is related with age, educational level, social class, insurance status, visits to the family doctor, alcohol consumption and free time physical exercise.
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Association of Late Marriage and Low Childbirth with Cervical Cancer Screening among Korean Women: Results from a Nationwide Survey. Cancers (Basel) 2022; 14:cancers14020327. [PMID: 35053489 PMCID: PMC8773928 DOI: 10.3390/cancers14020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 11/27/2022] Open
Abstract
Simple Summary Marriage and childbirth may affect adherence to cervical cancer screening. We have examined whether marriage and childbirth were associated with the adherence to cervical cancer screening among young adult women in Korea. Among 3925 women aged 20–39 years, 39.1% undertook cervical cancer screening within two years of eligibility. Compared with unmarried women, married women were more likely to adhere cervical cancer screening (adjusted odds ratio = 2.80, 95% CI: 2.99–3.44). And, as the number of births in married women increased, the adherence to cervical cancer screening increased. Abstract This study aimed to identify the association of marriage and childbirth with the adherence to cervical cancer screening among young adult women. Data across four years (2017–2020) of the cross-sectional Korean National Cancer Screening Survey were used. For measuring the adherence to cervical cancer screening, we used the cervical cancer screening rate with recommendation, which was defined as the percentage of women in the population eligible for screening who have had a cervical cancer screening within the past two years. Multiple logistic regression analysis was conducted to identify the association between marriage and adherence to cervical cancer screening. Overall, 3925 women aged 20–39 years were analyzed. Of these, 39.1% were screened for cervical cancer (26.6% unmarried and 57.1% married women). The married women had significantly higher adherence to cervical cancer screening than unmarried women (adjusted odds ratio = 2.80, 95% CI: 2.99–3.44). Compared with unmarried women, adherence to cervical cancer screening was significantly more likely to increase (p for trend, <0.001) in married women with an increased number of births. Our study confirmed that marriage and childbirth influence adherence to cervical cancer screening, suggesting that unmarried women may be vulnerable to cervical cancer.
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Hall R, Medina-Lara A, Hamilton W, Spencer AE. Attributes Used for Cancer Screening Discrete Choice Experiments: A Systematic Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:269-285. [PMID: 34671946 DOI: 10.1007/s40271-021-00559-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Evidence from discrete choice experiments can be used to enrich understanding of preferences, inform the (re)design of screening programmes and/or improve communication within public campaigns about the benefits and harms of screening. However, reviews of screening discrete choice experiments highlight significant discrepancies between stated choices and real choices, particularly regarding willingness to undergo cancer screening. The identification and selection of attributes and associated levels is a fundamental component of designing a discrete choice experiment. Misspecification or misinterpretation of attributes may lead to non-compensatory behaviours, attribute non-attendance and responses that lack external validity. OBJECTIVES We aimed to synthesise evidence on attribute development, alongside an in-depth review of included attributes and methodological challenges, to provide a resource for researchers undertaking future studies in cancer screening. METHODS A systematic review was conducted to identify discrete choice experiments estimating preferences towards cancer screening, dated between 1990 and December 2020. Data were synthesised narratively. In-depth analysis of attributes led to classification into four categories: test specific, service delivery, outcomes and monetary. Attribute significance and relative importance were also analysed. The International Society for Pharmacoeconomics and Outcomes Research conjoint analysis checklist was used to assess the quality of reporting. RESULTS Forty-nine studies were included at full text. They covered a range of cancer sites: over half (26/49) examined colorectal screening. Most studies elicited general public preferences (34/49). In total, 280 attributes were included, 90% (252/280) of which were significant. Overall, test sensitivity and mortality reduction were most frequently found to be the most important to respondents. CONCLUSIONS Improvements in reporting the identification, selection and construction of attributes used within cancer screening discrete choice experiments are needed. This review also highlights the importance of considering the complexity of choice tasks when considering risk information or compound attributes. Patient and public involvement and stakeholder engagement are recommended to optimise understanding of unavoidably complex choice tasks throughout the design process. To ensure quality and maximise comparability across studies, further research is needed to develop a risk-of-bias measure for discrete choice experiments.
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Affiliation(s)
- Rebekah Hall
- College of Medicine and Health, University of Exeter, South Cloisters, St Luke's Campus, Heavitree, Exeter, EX1 2LU, UK.
| | - Antonieta Medina-Lara
- College of Medicine and Health, University of Exeter, South Cloisters, St Luke's Campus, Heavitree, Exeter, EX1 2LU, UK
| | - Willie Hamilton
- College of Medicine and Health, University of Exeter, South Cloisters, St Luke's Campus, Heavitree, Exeter, EX1 2LU, UK
| | - Anne E Spencer
- College of Medicine and Health, University of Exeter, South Cloisters, St Luke's Campus, Heavitree, Exeter, EX1 2LU, UK
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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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Malmqvist J, Siersma V, Hestbech MS, Nicolaisdóttir DR, Bang CW, Brodersen J. Psychosocial consequences of invitation to colorectal cancer screening: a matched cohort study. J Epidemiol Community Health 2021; 75:867-873. [PMID: 33622803 PMCID: PMC8372396 DOI: 10.1136/jech-2019-213360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/30/2020] [Accepted: 01/18/2021] [Indexed: 12/28/2022]
Abstract
Background Psychosocial consequences of colorectal cancer (CRC) screening can arise anywhere in the screening cascade. Previous studies have investigated the consequences of participating in CRC screening; however, we have not identified any studies investigating the psychosocial consequences of receiving the invitation. Therefore, the objective of this study was to investigate psychosocial consequences of invitation to CRC screening. Methods The study was a longitudinal study performed in Region Zealand, Denmark. Participants included in this study were a random sample of 1000 CRC screening invitees and 1000 control persons, not invited to screening, matched in a 1:1 design on sex, age and municipality. We assessed psychosocial consequences before and after invitation in both study groups concurrently. The primary outcomes were psychosocial consequences measured with the condition-specific questionnaire Consequences of Screening in ColoRectal Cancer. Results Preinvitation response rates were 575 (57.5%) and 610 (61.0%) for the invitation group and control group, respectively. Postinvitation response rates were 442 (44.2%) for the invitation group and 561 (56.1%) for the control group. No differences in mean change in scale score were seen except for the scale ‘Change in body perception’. The invitation group had a 0.39 lower change (99% CI (−0.78 to −0.004), p=0.009) in mean score than the control group in the direction of a less negative body perception after invitation. Conclusions This study did not identify an association between invitation to CRC screening and negative psychosocial consequences.
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Affiliation(s)
- Jessica Malmqvist
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark .,Primary Health Care Research Unit, Region Zealand, Soroe, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mie Sara Hestbech
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dagný Rós Nicolaisdóttir
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christine Winther Bang
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Soroe, Denmark
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Effectiveness of the cervical cancer prevention programme: a case-control mortality audit in Lithuania. Eur J Cancer Prev 2020; 29:504-510. [PMID: 32932287 DOI: 10.1097/cej.0000000000000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The cervical cancer burden in Lithuania has remained high, and there are no previous effectiveness studies of cervical cancer prevention programme in the country. We investigated the effect of a prevention programme on the risk of mortality from cervical cancer in Lithuania by conducting a mortality audit study. The register-based case-control study included 715 cervical cancer deaths that occurred during 2010-2015 in Lithuania and their 2145 matched controls. Screening histories for cases and controls were obtained from the National Health Insurance Fund database. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression and corrected for self-selection bias. Index screening was associated with a 56% reduction in the cervical cancer death risk, OR: 0.44; 95% CI 0.26-0.74. The ORs for stage I and stage II+ cancers were 0.80; 95% CI 0.32-2.00 and 0.36; 95% CI 0.21-0.62, respectively. The preventive effect was statistically significant for women aged ≥40 years, while nonsignificant for younger. In women who died of cervical cancer, 71% were not invited and 88% were not screened within the recommended 36 months prior to index date. Among cases with index invitation, 32% had index screening compared to 70% in controls. In conclusion, participation in screening has been effective in reducing cervical cancer mortality in Lithuania. The study shows poor screening attendance, emphasizing the importance of greater efforts at the national level to improve the effectiveness of the screening.
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Augustin J, Sorbe C, Augustin M, Zander N, Kis A. Regional variations in the use of statutory skin cancer screenings in Germany: population-based spatial multisource analysis. J Eur Acad Dermatol Venereol 2020; 34:1736-1743. [PMID: 31981431 DOI: 10.1111/jdv.16228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/13/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Due to the increasing incidence of skin cancer, programmes for the prevention of skin cancer have been developed and implemented in Germany. However, utilization of skin cancer screenings shows marked regional differences. Reasons and predictors of such variations are unclear. OBJECTIVES The objective of the study is to identify predictors for regional use of skin cancer screening variations in Germany. METHODS Analysis of the population set of ambulatory claims data (2009-2015) of the statutory health insurances (SHI) in Germany (70.2 million people in 2015). Skin cancer screening utilization rate was determined on county level. Descriptive, cluster and multivariate analyses were performed to identify spatial patterns in skin cancer screening utilization. RESULTS Overall, 6.5-7.9 million people participated in skin cancer screenings. Utilization rates of people ≥35 years of age were 9.74% (2009) and 10.96% (2015). Marked regional variations were identified between the counties. Dermatologists in Saxony and Westphalia-Lippe as well as general practitioners in Lower Saxony and North Rhine showed particularly high utilization rates. Multiple regression analyses demonstrated e.g. positive associations between the skin cancer screening utilization rates and employees with higher vocational qualifications and shorter travel time by car to the nearest major urban centre. CONCLUSION Utilization rates of skin cancer screening vary largely in Germany with specific spatial patterns. Multivariate analyses demonstrate associations with socio-economic and geographical determinants. The results indicate the importance of health policy measures. These should be used in a more targeted manner in the regions in order to increase utilization of skin cancer screening.
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Affiliation(s)
- J Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - N Zander
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Kis
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Paulauskiene J, Ivanauskiene R, Skrodeniene E, Petkeviciene J. Organised Versus Opportunistic Cervical Cancer Screening in Urban and Rural Regions of Lithuania. ACTA ACUST UNITED AC 2019; 55:medicina55090570. [PMID: 31500116 PMCID: PMC6780374 DOI: 10.3390/medicina55090570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 01/12/2023]
Abstract
Background and Objectives: In 2004, Lithuania started the Nationwide Cervical Cancer Screening Programme. However, screening is more opportunistic than population-wide and the programme’s coverage is insufficient. The aim of this study was to assess the effect of systematic personal invitation on coverage of cervical cancer (CC) screening in urban and rural regions of Lithuania. Materials and Methods: The study was conducted in an urban primary healthcare centre (PHCC) and in a rural PHCC, where prevailing CC screening practice was highly opportunistic. Over the first year, all women aged 25–60 who had not received a Pap smear test within the last three years in urban (n = 1591) and rural (n = 1843) PHCCs received a personal invitation letter to participate in the screening. Over the second year, the reminder letter was sent to the non-attendees (n = 1042 in urban and n = 929 in rural PHCCs). A random sample of women (n = 93), who did not attend for screening after two letters, was contacted by phone in order to identify the barriers of non-attendance. Results: Before the study, only 9.6% of the target population in urban and 14.7% in rural PHCCs participated in CC screening. After the first invitation letter, the participation in CC screening increased up to 24.6% in urban and 30.8% in rural areas (p < 0.001). After the reminder letter, the attendance was 16.4% in urban and 22.2% in rural PHCCs (p < 0.001). The most common barriers for the non-attendance were lack of time, long waiting time for family doctor’s appointment, worries that a Pap test might be unpleasant and preventive gynaecological examination outside of the screening program. Conclusions: A systematic personal invitation with one reminder letter significantly increased the coverage of CC screening and was more effective in rural regions than in urban regions. The assessed barriers for non-attendance can be used to improve the coverage of screening.
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Affiliation(s)
- Justina Paulauskiene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT 47181 Kaunas, Lithuania.
| | - Rugile Ivanauskiene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT 47181 Kaunas, Lithuania.
| | - Erika Skrodeniene
- Department of Laboratory Medicine, Medical Academy, Lithuanian University of Health Sciences, LT 44307 Kaunas, Lithuania.
| | - Janina Petkeviciene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT 47181 Kaunas, Lithuania
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Nessler K, Chan SKF, Ball F, Storman M, Chwalek M, Krztoń-Królewiecka A, Kryj-Radziszewska E, Windak A. Impact of family physicians on cervical cancer screening: cross-sectional questionnaire-based survey in a region of southern Poland. BMJ Open 2019; 9:e031317. [PMID: 31473624 PMCID: PMC6720140 DOI: 10.1136/bmjopen-2019-031317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Despite worldwide efforts in encouraging routine pap smears for early detection of cervical cancer, Poland's screening rate lags behind the rest of the European Union at 20.2%. Family physicians (FPs) in Poland rarely perform pap smears, and little is known about the experiences and attitudes of Polish patients regarding pap smear screening in a primary healthcare (PHC) setting. METHODS A cross-sectional questionnaire-based survey was performed. Questionnaires were distributed among 43 FPs and 418 of their patients in one Polish region. The data from patients were associated with the doctors' characteristics. Descriptive statistics, the χ2 test and the Mann-Whitney U test were used for analysis. RESULTS Nearly two-thirds of patients (66%) declared willingness to undergo free pap smear screening by their FPs, with the most common reason being time saved. Among those objecting to receive pap smears from their FPs, immediate specialist care provided by gynaecologists in case of adverse results was the main concern. The factors that positively influenced the patients' decision to undergo cervical cancer screening in PHC were: (1) living in a city with more than 100 000 inhabitants, (2) being single, (3) having a female FP or (4) a physician with specialty training in family medicine. CONCLUSION There is high level of acceptance for pap smears performed in PHC offices among patients in Poland. They are more likely to comply with the screening due to easy access. Establishing a solid physician-patient relationship is also crucial in encouraging screening.
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Affiliation(s)
- Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Sze Kay Florence Chan
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Francis Ball
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Monika Storman
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Michal Chwalek
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | | | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
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15
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Tapera O, Kadzatsa W, Nyakabau AM, Mavhu W, Dreyer G, Stray-Pedersen B, SJH H. Sociodemographic inequities in cervical cancer screening, treatment and care amongst women aged at least 25 years: evidence from surveys in Harare, Zimbabwe. BMC Public Health 2019; 19:428. [PMID: 31014308 PMCID: PMC6480834 DOI: 10.1186/s12889-019-6749-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/04/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cervical cancer is the most commonly diagnosed cancer among women in Zimbabwe; however; access to screening and treatment services remain challenged. The objective of this study was to investigate socio-demographic inequities in cervical cancer screening and utilization of treatment among women in Harare, Zimbabwe. METHODS Two cross sectional surveys were conducted in Harare with a total sample of 277 women aged at least 25 years. In the community survey, stratified random sampling was conducted to select 143 healthy women in Glen View, Cranborne, Highlands and Hopely communities of Harare to present high, medium, low density suburbs and rural areas respectively. In the patient survey, 134 histologically confirmed cervical cancer patients were also randomly selected at Harare hospital, Parirenyatwa Hospital and Island Hospice during their routine visits or while in hospital admission. All consenting participants were interviewed using a validated structured questionnaire programmed in Surveytogo software in an android tablet. Data was analyzed using STATA version 14 to yield descriptive statistics, bivariate and multivariate logistic regression outcomes for the study. RESULTS Women who reported ever screening for cervical cancer were only 29%. Cervical cancer screening was less likely in women affiliated to major religions (p < 0.05) and those who never visited health facilities or doctors or visited once in previous 6 months (p < 0.05). Ninety-two (69%) of selected patients were on treatment. Women with cervical cancer affiliated to protestant churches were 68 times [95% CI: 1.22 to 381] more likely to utilize treatment and care services compared to those in other religions (p = 0.040). Province of residence, education, occupation, marital status, income (personal and household), wealth, medical aid status, having a regular doctor, frequency of visiting health facilities, sources of cervical cancer information and knowledge of treatability of cervical cancer were not associated with cervical cancer screening and treatment respectively. CONCLUSION This study revealed few variations in the participation of women in cervical cancer screening and treatment explained only by religious affiliations and usage of health facilities. Strengthening of health education in communities including churches and universal healthcare coverage are recommended strategies to improve uptake of screening and treatment of cervical cancer.
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Affiliation(s)
- O. Tapera
- University of Pretoria, School of Health Systems and Public Health, Pretoria, South Africa
| | - W. Kadzatsa
- Parirenyatwa Group of Hospitals, Radiotherapy Centre, Harare, Zimbabwe
| | - A. M. Nyakabau
- Parirenyatwa Group of Hospitals, Radiotherapy Centre, Harare, Zimbabwe
| | - W. Mavhu
- Centre for Sexual Health & HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
| | - G. Dreyer
- Department of Obstetrics and Gynaecology, University of Pretoria, Gynaecologic Oncology, Pretoria, South Africa
| | - B. Stray-Pedersen
- Institute of Clinical Medicine, University in Oslo and Womens’ Clinic, Oslo University Hospital, Oslo, Norway
| | - Hendricks SJH
- Sefako Makgatho Health Sciences University, Pretoria, South Africa
- University of Fort Hare, East London, South Africa
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Lindsø Andersen P, Olsen J, Saunte DM, Jemec GBE. Nonattendance in an Outpatient Clinic among Patients with Hidradenitis Suppurativa. Skin Appendage Disord 2019; 5:189-190. [PMID: 31049346 DOI: 10.1159/000493742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/14/2018] [Indexed: 01/25/2023] Open
Affiliation(s)
- Pernille Lindsø Andersen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Olsen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Marie Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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Trends in cervical cancer mortality rates in Lithuania, 1987–2016. Cancer Epidemiol 2018; 57:85-89. [DOI: 10.1016/j.canep.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/21/2018] [Accepted: 10/11/2018] [Indexed: 11/19/2022]
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