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Muslin C. Addressing the burden of cervical cancer for Indigenous women in Latin America and the Caribbean: a call for action. Front Public Health 2024; 12:1376748. [PMID: 38807996 PMCID: PMC11130434 DOI: 10.3389/fpubh.2024.1376748] [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: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
Cervical cancer, primarily caused by human papillomavirus (HPV) infection, poses a significant global health challenge. Due to higher levels of poverty and health inequities, Indigenous women worldwide are more vulnerable to cervical cancer than their non-Indigenous counterparts. However, despite constituting nearly 10% of the population in Latin America and the Caribbean (LAC), the true extent of the burden of cervical cancer among Indigenous people in this region remains largely unknown. This article reviews the available information on cervical cancer incidence and mortality, as well as HPV infection prevalence, among Indigenous women in LAC. The limited existing data suggest that Indigenous women in this region face a heightened risk of cervical cancer incidence and mortality compared to non-Indigenous women. Nevertheless, a substantial knowledge gap persists that must be addressed to comprehensively assess the burden of cervical cancer among Indigenous populations, especially through enhancing cancer surveillance across LAC countries. Numerous structural, social and cultural barriers hindering Indigenous women's access to HPV vaccination and cervical cancer screening worldwide have been identified and are reviewed in this article. The discussion highlights the critical role of culturally sensitive education, community engagement, and empowerment strategies in overcoming those barriers. Drawing insights from the success of targeted strategies in certain high-income countries, the present article advocates for research, policies and healthcare interventions tailored to the unique context of LAC countries.
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Affiliation(s)
- Claire Muslin
- One Health Research Group, Faculty of Health Sciences, Universidad de las Américas, Quito, Ecuador
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Gibson-Helm M, Slater T, MacDonald EJ, Stevenson K, Adcock A, Geller S, Parag V, Lambert C, Bennett M, Hibma M, Sykes P, Saville M, Hawkes D, Stanton JA, Clueard MA, Jelley G, Lawton B. Te Ara Waiora-Implementing human papillomavirus (HPV) primary testing to prevent cervical cancer in Aotearoa New Zealand: A protocol for a non-inferiority trial. PLoS One 2023; 18:e0280643. [PMID: 36952546 PMCID: PMC10035917 DOI: 10.1371/journal.pone.0280643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Cervical cancer is caused by high-risk types of human papillomavirus (HPV). Testing for high-risk HPV is a more sensitive screening method than cervical cytology for detecting cervical changes that may lead to cancer. Consistent with recent evidence of efficacy and acceptability, Aotearoa New Zealand plans to introduce HPV testing as the primary approach to screening, replacing cervical cytology, from mid-2023. Any equitable cervical screening programme must be effective across a diverse population, including women that the current programme fails to reach, particularly Māori and those in rural areas. Currently, we do not know the best model for implementing an equitable HPV self-testing screening programme. METHODS This implementation trial aims to assess whether a universal offer of HPV self-testing (offered to all people eligible for cervical screening) achieves non-inferior screening coverage (equal) to a universal offer of cervical cytology alone (the present programme). The study population is all people aged from 24.5 to 70 years due for cervical screening in a 12-month period (including those whose screening is overdue or who have never had screening). A range of quantitative and qualitative secondary outcomes will be explored, including barriers and facilitators across screening and diagnostic pathways. This study takes place in Te Tai Tokerau/Northland which covers a diverse range of urban and rural areas and has a large Indigenous Māori population. A total of fourteen practices will be involved. Seven practices will offer HPV self-testing universally to approximately 2800 women and will be compared to seven practices providing routine clinical care (offer of cervical cytology) to an approximately equal number of women. DISCUSSION This trial will answer important questions about how to implement an equitable, high-quality, effective national programme offering HPV self-testing as the primary screening method for cervical cancer prevention. TRIAL REGISTRATION Prospectively registered with the Australian New Zealand Clinical Trials Registry 07/12/2021: ACTRN12621001675819.
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Affiliation(s)
- Melanie Gibson-Helm
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Tania Slater
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Evelyn J MacDonald
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Kendall Stevenson
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Anna Adcock
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Stacie Geller
- National Center of Excellence in Women's Health, University of Illinois, Chicago, IL, United States of America
| | - Varsha Parag
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Charles Lambert
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Matthew Bennett
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | - Merilyn Hibma
- Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Peter Sykes
- Christchurch Hospital and University of Otago, Canterbury, New Zealand
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia
| | - David Hawkes
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia
| | - Jo-Ann Stanton
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
| | | | - Grahame Jelley
- Mahitahi Hauora Primary Health Entity, Northland, New Zealand
| | - Bev Lawton
- Te Tātai Hauora o Hine-National Centre for Women's Health Research Aotearoa (NCWHRA), Victoria University of Wellington, Wellington, New Zealand
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Edmonds LK, Cram F, Bennett M, Lambert C, Adcock A, Stevenson K, Geller S, MacDonald EJ, Bennett T, Storey F, Gibson-Helm M, Ropitini S, Taylor B, Bell V, Hoskin C, Lawton B. Hapū Ora (pregnancy wellness): Māori research responses from conception, through pregnancy and ‘the first 1000 days’ – a call to action for us all. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2075401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Liza K. Edmonds
- Kōhatu Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin, Aotearoa New Zealand
- Department of Women’s and Children’s, Otago School of Medicine, University of Otago, Dunedin, Aotearoa New Zealand
| | - Fiona Cram
- Katoa Limited, Auckland, Aotearoa New Zealand
| | - Matthew Bennett
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Charlie Lambert
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Anna Adcock
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Kendall Stevenson
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Stacie Geller
- Department of Obstetrics and Gynaecology, University of Illinois, Chicago, IL, USA
| | - Evelyn Jane MacDonald
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Tina Bennett
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Francesca Storey
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Melanie Gibson-Helm
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Sidney Ropitini
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Brittany Taylor
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Victoria Bell
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Caitlin Hoskin
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Beverly Lawton
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
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Brewer N, Bartholomew K, Grant J, Maxwell A, McPherson G, Wihongi H, Bromhead C, Scott N, Crengle S, Foliaki S, Cunningham C, Douwes J, Potter JD. Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 16:100265. [PMID: 34590066 PMCID: PMC8427317 DOI: 10.1016/j.lanwpc.2021.100265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/01/2021] [Accepted: 08/08/2021] [Indexed: 12/02/2022]
Abstract
Background Internationally, self-sampling for human papillomavirus (HPV) has been shown to increase participation in cervical-cancer screening. In Aotearoa New Zealand, there are long-standing ethnic inequalities in cervical-cancer screening, incidence, and mortality, particularly for indigenous Māori women, as well as Pacific and Asian women. Methods We invited never- and markedly under-screened (≥5 years overdue) 30-69-year-old Māori, Pacific, and Asian women to participate in an open-label, three-arm, community-based, randomised controlled trial, with a nested sub-study. We aimed to assess whether two specific invitation methods for self-sampling improved screening participation over usual care among the least medically served populations. Women were individually randomised 3:3:1 to: clinic-based self-sampling (CLINIC – invited to take a self-sample at their usual general practice); home-based self-sampling (HOME – mailed a kit and invited to take a self-sample at home); and usual care (USUAL – invited to attend a clinic for collection of a standard cytology sample). Neither participants nor research staff could be blinded to the intervention. In a subset of general practices, women who did not participate within three months of invitation were opportunistically invited to take a self-sample, either next time they attended a clinic or by mail. Findings We randomised 3,553 women: 1,574 to CLINIC, 1,467 to HOME, and 512 to USUAL. Participation was highest in HOME (14.6% among Māori, 8.8% among Pacific, and 18.5% among Asian) with CLINIC (7.0%, 5.3% and 6.9%, respectively) and USUAL (2.0%, 1.7% and 4.5%, respectively) being lower. In fully adjusted models, participation was statistically significantly more likely in HOME than USUAL: Māori OR=9.7, (95%CI 3.0-31.5); Pacific OR=6.0 (1.8-19.5); and Asian OR=5.1 (2.4-10.9). There were no adverse outcomes reported. After three months, 2,780 non-responding women were invited to participate in a non-randomised, opportunistic, follow-on substudy. After 6 months,192 (6.9%) additional women had taken a self-sample. Interpretation Using recruitment methods that mimic usual practice, we provide critical evidence that self-sampling increases screening among the groups of women (never and under-screened) who experience the most barriers in Aotearoa New Zealand, although the absolute level of participation through this population approach was modest. Follow-up for most women was routine but a small proportion required intensive support. Trial registration ANZCTR Identifier: ACTRN12618000367246 (date registered 12/3/2018) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371741&isReview=true; UTN: U1111-1189-0531 Funding Health Research Council of New Zealand (HRC 16/405) Protocol http://publichealth.massey.ac.nz/assets/Uploads/Study-protocol-V2.1Self-sampling-for-HPV-screening-a-community-trial.pdf
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Affiliation(s)
- Naomi Brewer
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | - Jane Grant
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | - Anna Maxwell
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | | | - Helen Wihongi
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | - Collette Bromhead
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Nina Scott
- University of Auckland, Waikato District Health Board, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Sunia Foliaki
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Chris Cunningham
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - John D Potter
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Sethi S, Poirier B, Canfell K, Smith M, Garvey G, Hedges J, Ju X, Jamieson LM. Working towards a comprehensive understanding of HPV and cervical cancer among Indigenous women: a qualitative systematic review. BMJ Open 2021; 11:e050113. [PMID: 34193502 PMCID: PMC8246376 DOI: 10.1136/bmjopen-2021-050113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Indigenous peoples carry a disproportionate burden of infectious diseases and cancers and are over-represented among the socially disadvantaged of most countries. Human papillomavirus (HPV) is a risk factor and causative agent of cervical, oropharyngeal and other cancers. Recent literature shows evidence of Indigenous populations being at increased risk of HPV infections and its associated cancers. OBJECTIVE This is a qualitative systematic review. The objective of this study was to explore the experiences and barriers Indigenous women face in relation to HPV awareness, knowledge and cervical screening, in order to better understand factors that may mitigate against or facilitate prevention efforts for HPV infection and associated cancers. METHODS Two investigators independently searched MEDLINE, PubMed, SCOPUS and Web of Science databases (for articles published from inception until 30 June 2020) using a prespecified search strategy to identify qualitative studies on narratives of Indigenous women regarding HPV infection awareness, knowledge and cervical screening, across all geographic and income-level settings. Using a 'meta-study' approach, a social ecological model of cervical screening, infection and associated cancer prevention among Indigenous populations was formulated. RESULTS Five core themes were identified and formulated within the social ecological model; intrapersonal factors, interpersonal factors, institutional/organisational factors, sociocultural/community factors and public policy. These collectively formed the proposed social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women. This model has been synthesised by taking into account personal stories of Indigenous women and healthcare workers, thus offering a more nuanced, organised, structured and culturally sensitive approach to policy translation. CONCLUSION The social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women offers a holistic and practical approach for Indigenous health policy makers. It clearly addresses the high risk of Indigenous populations at a global level in experience of both HPV infection and HPV-related cancers. PROSPERO REGISTRATION NUMBER CRD42020207643.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Brianna Poirier
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Megan Smith
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Brisbane Office, Brisbane, Queensland, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Whop LJ, Smith MA, Butler TL, Adcock A, Bartholomew K, Goodman MT, Winer RL, Milosevic E, Lawton B. Achieving cervical cancer elimination among Indigenous women. Prev Med 2021; 144:106314. [PMID: 33678228 DOI: 10.1016/j.ypmed.2020.106314] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/27/2020] [Accepted: 11/02/2020] [Indexed: 01/16/2023]
Abstract
Achieving the World Health Organisation (WHO) cervical cancer elimination target of fewer than four new cases per 100,000 woman-years requires scaling up HPV vaccination of girls, cervical screening, and pre-cancer and cancer treatment. We reviewed data from four high-income colonised countries (Australia, Canada, Aotearoa New Zealand (NZ), and the United States (US)) to identify how each is currently performing compared to the cervical cancer incidence elimination and triple-intervention targets, nationally and in Indigenous women. We also summarise barriers and enablers to meeting targets for Indigenous women. To achieve elimination, cervical cancer incidence must be reduced by 74% in Indigenous women in Australia, and 63% in Maori women in NZ; data were not published in sufficient detail to compare incidence in Indigenous women in Canada or the US to the WHO target. Only Australia meets the vaccination coverage target, but uptake appears comparatively equitable within Australia, NZ and the US, whereas there appears to be a substantial gap in Canada. Screening coverage is lower for Indigenous women in all four countries though the differential varies by country. Currently, only Australia universally offers HPV-based screening. Data on pre-cancer and cancer treatment were limited in all countries. Large inequities in cervical cancer currently exist for Indigenous peoples in Australia, Canada, New Zealand and the US, and elimination is not on track for all women in these countries. Current data gaps hinder improvements. These countries must urgently address their systemic failure to care and provide health care for Indigenous women.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Tamara L Butler
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anna Adcock
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Auckland, New Zealand
| | - Marc T Goodman
- Cedars-Sinai Cancer and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth Milosevic
- Canadian Partnership Against Cancer, Toronto, Canada; Global Health Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Beverley Lawton
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
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