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Salta S, Sequeira JP, Lobo J, Sousa A, Sousa H, Baldaque I, Monteiro P, Tavares F, Henrique R, Jerónimo C. Preliminary outcomes of the Cervical Cancer Screening Program of Northern Portugal: A snapshot. J Infect Public Health 2024; 17:1057-1064. [PMID: 38705058 DOI: 10.1016/j.jiph.2024.04.020] [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: 12/13/2023] [Revised: 04/07/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Cervical cancer screening remains an essential preventive tool worldwide. First line high-risk Human Papillomavirus (HrHPV) genotyping became gold standard for cervical cancer screening, and has been adopted by several countries, including Portugal. Herein, we aimed to assess the early outcomes of the regional Cervical Cancer Screening Program of Northern Portugal. METHODS The analysis of a representative set of cases evaluated during a one-month period (January 2020), with adequate follow-up was performed. Descriptive analysis was performed. RESULTS Overall, 7278 samples were received, of which 15.2% were HrHPV positive, most of these disclosing a negative result in subsequent liquid-based cytology. Nearly half of the HrHPV-positive women were referred to colposcopy. Within this group, HPV16/18+ cases depicted the higher frequency of high-grade squamous intraepithelial lesion (HSIL) or worse, compared with abnormal cytology or persistent HrHPV infection. Among women with non-HPV16/18 HrHPV infection and negative cytology, which are eligible for repeat sampling in one year, 65% were re-tested. Importantly, nearly half of these cleared HrHPV infection. Furthermore, referral to colposcopy due to HPV16/18 infection and/or abnormal cytology results were associated with > 40% risk for HSIL or worse lesion. CONCLUSIONS Our study confirmed the reliability and effectiveness of first line HrHPV genotyping in the Cervical Cancer Screening Program of Northern Portugal. Nonetheless, it also raised concerns about excessive referral to colposcopy, with the inherent human and financial costs. Thus, further improvement and optimization are key to ensure the sustainability of the program.
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Affiliation(s)
- Sofia Salta
- Cancer Biology & Epigenetics Group, Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal; Doctoral Program in Pathology and Molecular Genetics, ICBAS - School of Medicine and Biomedical Sciences - University of Porto, Rua Jorge Viterbo Ferreira 228, Porto 4050-513, Portugal
| | - José Pedro Sequeira
- Cancer Biology & Epigenetics Group, Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal; Doctoral Program in Biomedical Sciences, ICBAS - School of Medicine and Biomedical Sciences - University of Porto, Rua Jorge Viterbo Ferreira 228, Porto 4050-513, Portugal
| | - João Lobo
- Cancer Biology & Epigenetics Group, Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal; Department of Pathology, Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal; Department of Pathology and Molecular Immunology, ICBAS - School of Medicine and Biomedical Sciences - University of Porto, Rua Jorge Viterbo Ferreira 228, Porto 4050-513, Portugal
| | - Ana Sousa
- Molecular Oncology & Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal; Escola Superior de Saúde Fernando Pessoa - ESS-FP, R. Delfim Maia 334, Porto 4200-256, Portugal
| | - Hugo Sousa
- Molecular Oncology & Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal; Department of Pathology and Laboratory Medicine, Clinical Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal; Clinical Pathology Service, Centro Hospitalar Entre Douro e Vouga E.P.E., R. Dr. Cândido Pinho, Santa Maria da Feira 4520-211, Portugal
| | - Inês Baldaque
- Department of Pathology and Laboratory Medicine, Clinical Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Paula Monteiro
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Fernando Tavares
- Administração Regional de Saúde do Norte, I.P., Rua de Santa Catarina 1288, Porto 4000-477, Portugal
| | - Rui Henrique
- Cancer Biology & Epigenetics Group, Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal; Department of Pathology, Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal; Department of Pathology and Molecular Immunology, ICBAS - School of Medicine and Biomedical Sciences - University of Porto, Rua Jorge Viterbo Ferreira 228, Porto 4050-513, Portugal.
| | - Carmen Jerónimo
- Cancer Biology & Epigenetics Group, Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), R. Dr. António Bernardino de Almeida, Porto 4200-072, Portugal; Department of Pathology and Molecular Immunology, ICBAS - School of Medicine and Biomedical Sciences - University of Porto, Rua Jorge Viterbo Ferreira 228, Porto 4050-513, Portugal.
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Gunes AC, Ozgul N, Turkyılmaz M, Kara F, Unlu F, Ayhan A, Gultekin M. Evaluation of colposcopy after the addition of human papillomavirus testing to the Turkish cervical cancer screening program. Cancer Med 2023; 12:21751-21760. [PMID: 37994572 PMCID: PMC10757080 DOI: 10.1002/cam4.6740] [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: 06/07/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE To evaluate colposcopy performance following the human papillomavirus (HPV) DNA screening program in Turkey. METHODS Women aged 30-65 years are screened for cervical cancer every 5 years, with individuals positive for HPV 16 and/or 18 or other high-risk HPV types with abnormal cytology referred for colposcopy. Both HPV test and cytology are obtained at the same visit. If HPV is negative, cytology will not be assessed. However, if HPV is positive, both cytology and HPV genotyping will be performed. Colposcopy-require was defined as HPV 16/18 positivity or abnormal smear results with any hrHPV positivity, and the remaining patients (normal smear with hrHPV positivity other than HPV 16/18) were grouped as colposcopy non-required. National data on colposcopy outcomes and unnecessary performance rates in February 2018-2019 were evaluated via a questionnaire. RESULTS A total of 9808 patients were included, divided based on colposcopy requirement: 5751 (58.6%) patients required colposcopy and 4057 (41.4%) did not. Unnecessary colposcopy was performed on 90.1% of the non-required group (3657 of 4057 patients). In the colposcopy-required group, 4455 patients (79.9%) underwent punch biopsy; 3194 (57.1%), endocervical curettage (ECC); and 421 (7.5%), "see and treat" in the non-required group, the results were 2790 (76.3%), 1957 (53.2%), and 211 (5.7%), respectively. A total of 746 cervical intraepithelial neoplasia (CIN)-3 isolates were detected, including 702 using existing screening and triage with 94.1% sensitivity (702/746). Multiple biopsies were taken in 69.8% (n = 3110) of patients from the colposcopy-required group and 63.7% (n = 1777) from the non-required group. The ECC samples included 19 cervical cancers and 212 ≥CIN-3 lesions in the colposcopy-required group, and four cancers and 41 ≥CIN-3 lesions in the non-required group. The proportion of ≥CIN-3 lesions detected by ECC only was 4.7% (35 of 746 ≥CIN-3 lesions). CONCLUSION Our results showed high rates of unnecessary colposcopies, and a high percentage of multiple and random punch biopsies and ECC.
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Affiliation(s)
- Ali Can Gunes
- Mamak State HospitalDepartment of Obstetrics and GynecologyAnkaraTurkey
| | - Nejat Ozgul
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyHacettepe University Faculty of MedicineAnkaraTurkey
| | - Murat Turkyılmaz
- Department of Cancer ControlTurkish Ministry of Health, Public Health InstituteAnkaraTurkey
| | - Fatih Kara
- Department of Cancer ControlTurkish Ministry of Health, Public Health InstituteAnkaraTurkey
| | - Fahriye Unlu
- Department of Cancer ControlTurkish Ministry of Health, Public Health InstituteAnkaraTurkey
| | - Ali Ayhan
- Department of Obstetrics and GynecologyBaskent University Faculty of MedicineAnkaraTurkey
| | - Murat Gultekin
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyHacettepe University Faculty of MedicineAnkaraTurkey
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Marchadier A, Bezannier L, Barré-Pierrel S, Manceau A, A Abadie A, Detournay B. Overview of organisational methods of primary cervical lesion screening programmes that use human papillomavirus testing. J Med Screen 2023; 30:113-119. [PMID: 36974487 PMCID: PMC10399092 DOI: 10.1177/09691413231158932] [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: 08/09/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 03/29/2023]
Abstract
Many factors need to be considered when planning and managing a screening programme for the early detection of cervical cancer (CC). A non-systematic international review of the organisation of CC screening using high-risk human papillomavirus (HPV-HR) testing, aimed at identifying the organisational methods of these programmes, was conducted with a view to supporting the future of the French system in the context of the transition to HPV-HR testing. In countries where HPV testing has been implemented or planned, the initial reflection process has provided an opportunity to rethink the previous (cytological) screening organisation. Despite considerable differences between countries, a nationally or regionally centralised organisational model appears to be the preferred option in most countries. This model is based on a national/regional structure tasked with all invitations, reminders, follow-up and coordination, centralised laboratories integrating both biology and pathology laboratories, and a unified information system integrated with routine health management tools used by health practitioners and nurses. Besides quality considerations, grouped purchasing makes it possible to implement a public procurement policy that includes price negotiations with suppliers. Discussions around the introduction of HPV testing have resulted in most countries reviewing or creating information systems and quality assurance processes. While the WHO seems to recommend the systematic use of vaginal self-sampling, very few countries have considered this option. More and more countries are planning to implement vaginal self-sampling, but no clear organisational model has emerged from the countries where it has been implemented to date.
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Affiliation(s)
| | | | | | - Antoine Manceau
- PwC Advisory - Healthcare & Pharmaceuticals Life-Sciences, Neuilly-sur-Seine, France
| | - Audrey A Abadie
- PwC Advisory - Healthcare & Pharmaceuticals Life-Sciences, Neuilly-sur-Seine, France
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Sertkaya D, Şen Bayturan S. Pediatric and Family Physicians' Attitudes Regarding Childhood Optional Vaccines During the COVID-19 Pandemic. Cureus 2023; 15:e37338. [PMID: 37182049 PMCID: PMC10169092 DOI: 10.7759/cureus.37338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION To maintain high vaccination rates, vaccination interventions should be targeted according to interests such as parents' knowledge, attitudes, beliefs, and vaccine hesitancy. METHODS This research was conducted between June 2020 and April 2021 using a questionnaire about optional vaccines (OVs) in Turkey. RESULTS A total of 241 physicians participated and 14 physicians were excluded due to insufficient data. Finally, a total of 227 physicians, including 115 pediatricians and 112 family physicians, were included in the study. The mean age of pediatricians and family physicians was 33.42 ± 8.25 years and 35.46 ± 11.09 years, respectively. There was no significant difference between pediatricians and family physicians in terms of age and gender (p > 0.05). Nearly half of all physicians (49%) stated that they do not have sufficient knowledge about OVs. Pediatricians (64%) stated that they have sufficient knowledge at a higher rate than family physicians (37%) (p = 0.000). Physicians who declared having sufficient knowledge informed families about OVs more frequently than those with insufficient knowledge (p = 0.000). Pediatricians provide information about OVs more frequently than family physicians (p = 0.001). Rotavirus and meningococcal vaccines were the most frequently recommended vaccines. CONCLUSIONS Rotavirus and meningococcal B were the most recommended OVs. About half of the physicians participating in the study stated that they did not have sufficient knowledge about OVs. Physicians with sufficient knowledge of OVs recommend OVs more frequently.
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Affiliation(s)
| | - Semra Şen Bayturan
- Pediatric Infectious Diseases, Faculty of Medicine, Manisa Celal Bayar University, Manisa, TUR
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Taştekin Ouyaba A, İnfal Kesim S. Women's behaviours towards cervical cancer screening in the COVID-19 pandemic: A moderated-mediation-model based on Information-Motivation-Behavioural Skills. J Adv Nurs 2023; 79:125-134. [PMID: 36177523 DOI: 10.1111/jan.15447] [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: 01/23/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 12/15/2022]
Abstract
AIMS (1) To establish a predictive model based on the Information-Motivation-Behavioural Skills model, which can analyse the factors affecting the behaviours of women towards cervical cancer screening in the COVID-19 pandemic, and (2) to test the mediating effects of behavioural skills in the model, and (3) to test the moderated mediation effect of age. DESIGN A cross-sectional study was conducted among 354 women aged 30-65 between May and August 2021 in Turkey. METHODS Data were collected by using an online survey. The direct and indirect effects were tested in the structural equation model and the moderated-mediation effect was tested in the PROCESS macro. RESULTS Behavioural skills mediate the effect of motivation on cervical cancer screening behaviours. In addition, age has a moderated mediation effect on this mediation effect. CONCLUSION Our study revealed that as women's motivation for cervical cancer screening increased, their behavioural skills also increased. It can be stated that middle-aged and older women with higher behavioural skills are more likely to have screening during the pandemic and to comply with national recommendations. IMPACT This study is the first quantitative study to test the impact of the components of the Information-Motivation-Behavioural Skills model on cervical cancer screening during the COVID-19 pandemic. In addition, the results reveal the mediating effect of behavioural skills in the relationship between motivation and cervical cancer scanning behaviour and the moderated mediation effect of age. Our results can provide insight for nurses into how to triage women with delayed cervical cancer screening, how to build screening capacity, and how intervention strategies should be developed to improve compliance with cervical cancer screening and follow-up recommendations in women at risk during and after the pandemic.
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Affiliation(s)
- Ayşe Taştekin Ouyaba
- Afyonkarahisar Health Sciences University, Health Sciences Faculty, Afyonkarahisar, Turkey
| | - Selma İnfal Kesim
- Selçuk University, Akşehir Kadir Yallagöz Health High School, Konya, Turkey
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Akalin A. Knowledge and attitude towards human papillomavirus and its vaccination and affecting factors among nursing and medical students: a questionnaire study. J OBSTET GYNAECOL 2022; 42:3315-3321. [PMID: 36129449 DOI: 10.1080/01443615.2022.2124851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was to investigate the knowledge about the Human Papillomavirus (HPV), HPV testing and HPV vaccinations and affecting factors among nursing and medical students and explore their attitudes regarding HPV vaccination. A cross-sectional study was conducted with 635 undergraduate nursing and medical students from March to June 2020 at a state university in Turkey. The data were collected using the Questionnaire Form and HPV Knowledge Scale (HPV-KS). The HPV-KS mean scores of the students were 17.07 ± 6.95. The students were aged 26 and over, females, had good economic status, registered at the faculty of medicine, at higher year of studies, had sexual experience and recommended HPV vaccination got higher knowledge scores regarding HPV, HPV testing and HPV vaccination (p ˂ .05). Despite low vaccination rate (2.0%), almost all the students recommended the HPV vaccine (95.9%). Sex, place of residence, faculty (departments), and year of study are among the significant predictor of knowledge about HPV, HPV testing and HPV vaccinations level up to 39% (p ˂ .05). This study highlights the need for further education and training are required to increase the knowledge about HPV, HPV testing and HPV vaccination, which may help increase awareness and improve the ratio of vaccination.IMPACT STATEMENTWhat is already known on this subject? Human papillomavirus (HPV) is one of the most common sexually transmitted diseases and most likely to cause cervical cancer. Prophylactic vaccine administrations is critical in primary protection from HPV.What the results of this study add? The study revealed the needs for education among nursing and medical students about HPV, HPV testing and HPV vaccines. Knowledge regarding HPV, HPV testing and HPV vaccines is statistically significantly associated with age, sex, economic status, place of residence, faculty, year of study, sexual experience and recommending HPV vaccines. Sex, place of residence, faculty, and year of study are among the statistically significant positive predictors for HPV knowledge.What the implications are of these findings for clinical practice and/or further research? Educators should increase education and/or training opportunities related to HPV among nursing and medical students who are the future healthcare providers and in the risky group for HPV during undergraduate education.
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Affiliation(s)
- Ayse Akalin
- Department of Nursing, Faculty of Health Sciences, Düzce University, Düzce, Turkey
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Arslan HN, Oruc MA. Results from a cervical cancer screening program in Samsun, Turkey. BMC Womens Health 2022; 22:331. [PMID: 35927723 PMCID: PMC9354280 DOI: 10.1186/s12905-022-01916-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cervical cancer is a preventable disease. This study aimed to share the results of the national cervical cancer screening program performed in primary health care institutions in Samsun between 2015 and 2019. Methods Women aged 30–65 years who were screened for cervical cancer in screening centers of Samsun between January 01, 2015, and December 31, 2019, were included in this descriptive study. The data were obtained from the automation program of the “National Human Papilloma Virus (HPV) Laboratory Application” used by the Provincial Directorate of Health Cancer Unit through filtering the completion time of the tests, and all results were evaluated without sampling. Thus, data were presented using descriptive statistics. Results The mean age of 89,302 women included in the cervical cancer screening program was 45.9 ± 9.0 years. Of the samples obtained from the participants, 1.0% were determined as insufficient material, 94.1% as HPV-negative, and 4.9% as HPV-positive. The most common HPV genotypes were 16, 51, 31, and 52. Of the 4337 HPV-positive women, 74.7% of the pap smear results were negative (including infection, 36.5%), and the most common premalignant lesions were atypical squamous cells of undetermined significance in 7.1% and low-grade squamous intraepithelial lesions in 6.9%. HPV 16/18 was also observed in 31.7% of HPV-positive women. Seven hundred ninety-five women were referred to a specialist physician for further examination and treatment within the scope of the screening algorithm. Conclusion Detecting HPV-positivity by reaching more women within the national cervical cancer screening program’s scope is vital in fighting against this disease. The effectiveness of cancer screening programs should be increased by ensuring community participation through awareness activities.
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Students' Knowledge about Cervical Cancer Prevention in Poland. MEDICINA-LITHUANIA 2021; 57:medicina57101045. [PMID: 34684082 PMCID: PMC8539101 DOI: 10.3390/medicina57101045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 02/04/2023]
Abstract
Background and Objectives: In Poland, the rates of morbidity and mortality due to cervical cancer are amongst the highest in Europe. A significant percentage of newly diagnosed cases of cervical cancer are at an advanced stage. Unfortunately, only about 20% of Polish women take part in cervical cancer screening. The aim of the study was to assess students’ knowledge of cervical cancer risk factors and prevention. Materials and Methods: The study was provided to Polish students from various universities and faculties between May 2020 and November 2020. The questionnaire was designed specifically for this study and was validated. The chi-square test was used to compare the responses between subgroups. Results: The study was carried out on a group of 995 students (80.6% women, 19% men, 0.4% no data), (average age 21.9 years). Most students knew that the main risk factor for cervical cancer is human papillomavirus (HPV) infection (82% of all responders; 86% of medical students; 73% of non-medical students; p < 0.001). Only 40% of students knew that in Poland the Population Prevention and Early Diagnosis Program is carried out on women aged 25–59 years every three years. Most students correctly indicated that cervical cancer screening in Poland is performed using cervical cytology and were familiar with the basis of cytology. Only 57% of students knew that there are no specific early symptoms of cervical cancer. A total of 78% of all respondents knew that HPV vaccination reduces the risk of cervical cancer. Medical students and students who are sexually active demonstrated a better knowledge of cervical cancer. Conclusions: The Polish students had some knowledge of cervical cancer risk factors and primary and secondary prevention. Significantly better knowledge was demonstrated by medical students. Some efforts should be made to ensure that young people, who are not associated with medicine are better educated about cervical cancer in order to reduce the overall incidence and improve early detection rates.
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Oliveira AKDSGD, Jacyntho CMDA, Tso FK, Boldrini NAT, Speck NMDG, Peixoto RAC, Zanine RM, Melo YLMFD. HPV infection - Screening, diagnosis and management of HPV-induced lesions. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:240-246. [PMID: 33860509 PMCID: PMC10183895 DOI: 10.1055/s-0041-1727285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Yara Lucia Mendes Furtado de Melo
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Basu P, Alhomoud S, Taghavi K, Carvalho AL, Lucas E, Baussano I. Cancer Screening in the Coronavirus Pandemic Era: Adjusting to a New Situation. JCO Glob Oncol 2021; 7:416-424. [PMID: 33784177 PMCID: PMC8081552 DOI: 10.1200/go.21.00033] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/22/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The coronavirus-induced pandemic has put great pressure on health systems worldwide. Nonemergency health services, such as cancer screening, have been scaled down or withheld as a result of travel restrictions and resources being redirected to manage the pandemic. The present article discusses the challenges to cancer screening implementation in the pandemic environment, suggesting ways to optimize services for breast, cervical, and colorectal cancer screening. METHODS The manuscript was drafted by a team of public health specialists with expertise in implementation and monitoring of cancer screening. A scoping review of literature revealed the lack of comprehensive guidance on continuation of cancer screening in the midst of waxing and waning of infection. The recommendations in the present article were based on the advisories issued by different health agencies and professional bodies and the authors' understanding of the best practices to maintain quality-assured cancer screening. RESULTS A well-coordinated approach is required to ensure that essential health services such as cancer management are maintained and elective services are not threatened, especially because of resource constraints. In the context of cancer screening, a few changes in invitation strategies, screening and management protocols and program governance need to be considered to fit into the new normal situation. Restoring public trust in providing efficient and safe services should be one of the key mandates for screening program reorganization. This may be a good opportunity to introduce innovations (eg, telehealth) and consider de-implementing non-evidence-based practices. It is necessary to consider increased spending on primary health care and incorporating screening services in basic health package. CONCLUSION The article provides guidance on reorganization of screening policies, governance, implementation, and program monitoring.
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Affiliation(s)
- Partha Basu
- International Agency for Research on Cancer, Lyon, France
| | - Samar Alhomoud
- Section Colorectal Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Katayoun Taghavi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Graduate School for Cellular and Biomedical Sciences (GCB) of the University of Bern, Bern, Switzerland
| | | | - Eric Lucas
- International Agency for Research on Cancer, Lyon, France
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Kabaca C, Giray B, Guray Uzun M, Akis S, Purut YE, Keles Peker E, Cetiner H, Bostanci Ergen E. The meaning of high-risk HPV other than type 16/18 in women with negative cytology: Is it really safe to wait for 1 year? Diagn Cytopathol 2021; 49:480-486. [PMID: 33528903 DOI: 10.1002/dc.24705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is a primary risk factor for cervical cancer. HPV 16 and 18 are the two most carcinogenic genotypes and have been reported in the majority of cervical cancer. High-risk HPVs (hrHPVs) other than HPV 16/18 cause approximately a quarter of cervical cancers. We aimed to present the colposcopy-guided biopsy results of non-16/18 hrHPV-infected women with negative cytology. METHODS This is a retrospective cohort study conducted on 752 patients between the ages of 30-65 years with non-16/18 hrHPV and negative cytology undergoing colposcopy-guided biopsy at a tertiary gynecological cancer center between January-2016 and January-2019. RESULTS The mean age of the women was 42.35±9.41 years. Cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 49 (6.5%) women with negative cytology. The rate of CIN 2+ lesions in women with abnormal cytology was 12.8%. Patients with abnormal cytology had about 2.1 and 2.4 times increased the odds of CIN 2+ lesion in cervical biopsy and endocervical curettage specimens, respectively. CIN 3+ lesion was detected in 20 (2.7%) women with negative cytology. One (0.1%) of the patients with HPV 39 and negative cytology had invasive cervical cancer. The two most common HPV subtypes were HPV 31 and HPV 51. CONCLUSIONS The risk of cervical preinvasive lesions still can be detected and cannot be completely eliminated among hrHPV other than 16/18-infected women with negative cytology. Based on the results of this study, referral of non-16/18 hrHPV-infected women with negative cytology to colposcopy is supported as a credible and feasible strategy.
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Affiliation(s)
- Canan Kabaca
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Burak Giray
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mine Guray Uzun
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serkan Akis
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yunus Emre Purut
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Esra Keles Peker
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Handan Cetiner
- Department of Pathology, Zeynep Kamil Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Evrim Bostanci Ergen
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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How to triage HPV positive cases: Results of four million females. Gynecol Oncol 2020; 158:105-111. [PMID: 32362567 DOI: 10.1016/j.ygyno.2020.04.698] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/23/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the Turkey's nationwide HPV DNA screening program on the basis of first 4 million screened women. METHODS Women over age 30 were invited for screening via HPV DNA and conventional cytology. Single visit screen strategy was used to collect for both screening and triage (extended genotyping and conventional pap-smear). RESULTS A total of 4,099,230 patients had attended to HPV DNA cancer screening. 4.39% were found to be HPV DNA positive. The most common HPV type was 16, followed by 51, 31, 52, 56 and 18 at all age intervals and geographic regions. Cytology results were reported as "normal" in (69.2%), "inadequate sampling" in (16.6%) and as "abnormal (≥ASC-US)" in the remaining. Current Turkish screening with HPV DNA (referral to colposcopy with HPV 16 or 18 or any smear abnormality ≥ASC-US) gives overall PPV of 24.3% for ≥CIN2. Only Pap-Smear triage revealed PPV of 26.4% for ≥ASC-US thresholds. Comparison of different triage methods for ≥CIN2+ according to different HPV genotype revealed a PPV of 32,6% for HPV 16; 15,3% for HPV 18. This figure was 34.4%, 19.3%, 15.3% and 14.0% for HPV 33, 31, 45 and 35; respectively. CONCLUSION This study involves the largest series in the world summarizing a real-world experience with primary HPV DNA screening and triage with a single visit. The results show the feasibility and applicability of such screening method in developing countries with acceptable colposcopy referral rates. Among triage tests, only pap-smear seems to be effective without a need for extended genotyping.
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Alay I, Kaya C, Karaca I, Yildiz S, Baghaki S, Cengiz H, Ekin M, Yasar L. The effect of being diagnosed with human papillomavirus infection on women's sexual lives. J Med Virol 2019; 92:1290-1297. [PMID: 31696950 DOI: 10.1002/jmv.25623] [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] [Received: 09/03/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022]
Abstract
PROBLEM Objective studies that use validated questionnaires are needed to evaluate the changes in the sexual functions of women diagnosed with human papillomavirus (HPV) infection. METHOD OF STUDY The study comprised 80 sexually active women diagnosed with a high-risk HPV infection. These patients were divided into four groups as follows: group 1, HPV 16/18-positive and normal cytology; group 2, HPV 16/18-positive and abnormal cytology; group 3, non-16/18 HPV-positive and abnormal cytology; and group 4, non-16/18 HPV-positive and normal cytology. The sexual functions and anxiety statuses of the patients were assessed via the Female Sexual Function Index (FSFI) and Beck anxiety inventory (BAI) questionnaires, respectively, at their first clinical visits and then 2 months later. RESULTS There was no statistically significant difference among the study groups in terms of the overall FSFI and domain sub-scores at either of the visits. Women who tested positive for the high-risk HPV 16/18 strains had a significantly less sexual desire after being informed about the test results. Those with HPV 16/18 and normal cytology had significantly higher anxiety levels at their second than first visits. The BAI scores of the HPV 16/18-positive women (normal or abnormal cytology) at the second visit were significantly higher than those of non-16/18 HPV-positive women with normal cytology. There was no significant difference between the patients with normal and abnormal cytology results regarding the difference of BAI, overall and domain FSFI sub-scores at the first and second visits. The desire and lubrication domain scores of the HPV 16/18-positive patients significantly decreased after the first visit compared with those of the non-16/18 HPV-positive patients. CONCLUSION HPV 16/18 positivity decreases women's total FSFI and desire domain sub-scores.
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Affiliation(s)
- Ismail Alay
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ibrahim Karaca
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sukru Yildiz
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sema Baghaki
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Huseyin Cengiz
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Ekin
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Levent Yasar
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Gultekin M, Turan SH, Boztas G, Öztürk C, Hacikamiloğlu E. Passion for saving lives: Turkey between 2012 and 2017. Int J Gynecol Cancer 2019; 30:709-710. [PMID: 31792082 DOI: 10.1136/ijgc-2019-001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Murat Gultekin
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Guledal Boztas
- TC Sağlık Bakanlığı Ankara İl Sağlık Müdürlüğü, Ankara, Turkey
| | - Cansu Öztürk
- Ankara Kecioren Training and Research Hospital, Ankara, Turkey
| | - Ezgi Hacikamiloğlu
- Coordination Unit of The Programme for Improving Multisectoral Health Responsibility, TC Sağlık Bakanlığı, Ankara, Turkey
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Maver PJ, Poljak M. Primary HPV-based cervical cancer screening in Europe: implementation status, challenges, and future plans. Clin Microbiol Infect 2019; 26:579-583. [PMID: 31539637 DOI: 10.1016/j.cmi.2019.09.006] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/31/2019] [Accepted: 09/07/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cytology-based screening has been a cornerstone of cervical cancer prevention for decades. Following extensive evidence demonstrating higher sensitivity and accuracy, lower variability and better reproducibility of human papillomavirus (HPV)-based screening compared with conventional or liquid-based cytology, recent European guidelines strongly recommend primary HPV-based screening over standard cytology-based screening. In addition, HPV-based screening offers the possibility of self-sampling and makes possible longer screening intervals in women with negative screening results. OBJECTIVES We summarize the current status of implementation of HPV-based screening in Europe, describe the real-life experience and challenges from countries already performing HPV-based screening, and briefly review immediate and long-term plans for screening implementation in selected European countries. SOURCES Data were obtained from peer-reviewed literature, personal communication with experts and authorities involved in formulating national recommendations and practical guidelines, and relevant national websites. CONTENT As of July 2019, the Netherlands and Turkey are the only European countries with fully implemented national HPV-based cervical cancer screening. Italy, Sweden and Finland have already implemented HPV-based screening in several regions, and several other countries are at various stages of implementation. Some countries are considering transitioning from cytology-based to HPV-based screening, but are struggling with the suboptimal performance of current population-based programmes. Implementation of HPV-based screening has resulted in higher colposcopy referral rates, but also higher detection rates of CIN3+ lesions and cervical cancers requiring immediate treatment. Cytology is mostly used as a triage test, although other strategies are under consideration in some countries. IMPLICATIONS HPV-based screening is best suited in organized population-based screening settings. In 2019, cervical cancer screening policies across Europe vary greatly. Experience in countries with national and regional HPV-based screening already implemented is generally very positive. Urgent action is needed in many European countries, especially those with suboptimal opportunistic cytology-based cervical cancer screening.
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Affiliation(s)
- P J Maver
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia.
| | - M Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia.
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