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Zhu Z, Wang Y, Han J, Li Y. Associations of Pap test utilisation with comorbidity and functional impairment among middle-aged non-Hispanic black women in the USA: a cross-sectional analysis of the 2018 BRFSS data. BMJ Open 2024; 14:e076247. [PMID: 39053959 DOI: 10.1136/bmjopen-2023-076247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES Limited evidence exists on the association of Pap test utilisation with comorbidity and functional impairment among middle-aged non-Hispanic black (NHB) women in the USA. We aimed to assess whether middle-aged NHB women with a higher burden of comorbidity and functional impairment have a lower rate of Pap test utilisation. DESIGN Nationwide cross-sectional survey in the USA. SETTING 2018 Behavioral Risk Factor Surveillance System. PARTICIPANTS 6359 middle-aged NHB women. EXPOSURES AND OUTCOME The primary exposures were comorbidity and functional impairment. The outcome of interest was whether a woman reported having a Pap test in the last 3 years. DATA ANALYSIS We fit unadjusted and multivariable logistic regression models to calculate ORs and 95% CI for comorbidity and functional impairment. Sensitivity analysis was restricted to women without a history of hysterectomy or cancer. We added interaction terms between exposures and age, as well as lifestyle indicators. RESULTS Of the 6359 women, 4141 (65.1%) had comorbidity and 2429 (38.2%) had functional impairment. Middle-aged NHB women with comorbidity (≥2 vs 0, aOR=0.72, 95% CI=0.61 to 0.85, p trend<0.01) or functional impairment (≥2 vs 0, aOR=0.69, 95% CI=0.57 to 0.83, p trend<0.01) had a lower rate of Pap test utilisation compared with healthier counterparts, regardless of histories of hysterectomy and prior cancer. The analyses for age and lifestyle indicators subgroup difference indicated no statistically significant effect (p interaction>0.05). However, the magnitude of these associations was stronger among women with adverse lifestyle factors (eg, comorbidity ≥2 v.s. 0, aOR=0.53, 95% CI=0.40, to 0.71; functional impairment ≥2 v.s. 0, aOR=0.35, 95% CI=0.16, to 0.72 among binge drinkers). CONCLUSION Comorbidity or functional impairment could be a potential barrier to Pap test utilisation among middle-aged NHB women in the USA. Our study highlights the importance of implementing targeted intervention programmes and prioritised health resource allocation to promote Pap test utilisation. Cohort studies with clear temporality and indicators reflecting disease severity will be essential for further understanding this association.
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Affiliation(s)
- Zhikai Zhu
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yali Wang
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiefei Han
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Li
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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Nartey Y, Amo‐Antwi K, Hill P, Dassah E, Asmah R, Nyarko K, Agambire R, Konney T, Yarney J, Damale N, Cox B. Risk Factors for Cervical Cancer in Ghana. Cancer Rep (Hoboken) 2024; 7:e2124. [PMID: 39031901 PMCID: PMC11190583 DOI: 10.1002/cnr2.2124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND The major burden of cervical cancer occurs in low- and middle-income countries. In Ghana, it is the second most common cancer among women. Infection with high-risk human papilloma virus (HPV) has been established as the cause of cervical cancer. As such, it is important to identify risk factors that may affect progression from HPV infection to cancer. AIMS We assessed the risk factors assocaited with cervical cancer in Ghana. METHODS To identify the risk factors for cervical cancer, we conducted an unmatched case-control study in two hospitals in Ghana where most cervical cancer cases are diagnosed. Women with histologically confirmed cervical cancer were the cases, whereas women without cancer seeking care at the two hospitals were controls. A structured questionnaire was administered to the women, after which cervical samples were sent for HPV deoxyribonucleic acid (DNA) testing. RESULTS Overall, 206 cases and 230 controls were recruited. After adjusting for possible confounders, women with the highest educational level had a significantly lower risk of cervical cancer than those with no or little formal education. Parity was a major risk factor (odd ratio [OR] for five or more children = 7.9; 95% CI: 2.3-27.6), with risk increasing with increasing parity (p for trend <0.001). Women reporting the use of a homemade sanitary towel during menstruation also had an increased risk of cervical cancer compared with women who used a pad (OR: 7.3; 95% CI: 2.5-22.0). CONCLUSION In this Ghanaian population, high parity and poor personal hygienic conditions were the main contributing factors to the risk of cervical cancer after adjustment for the presence of high-risk HPV genotypes.
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Affiliation(s)
- Yvonne Nartey
- Department of Adult Health, School of Nursing and MidwiferyUniversity of GhanaLegonGhana
| | - Kwabena Amo‐Antwi
- School of Medicine and DentistryKwame Nkrumah University of Science & Technology/Komfo Anokye Teaching HospitalKumasiGhana
| | - Philip C. Hill
- Centre for International Health, Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Edward T. Dassah
- School of Medicine and DentistryKwame Nkrumah University of Science & Technology/Komfo Anokye Teaching HospitalKumasiGhana
| | - Richard H. Asmah
- Department of Biomedical SciencesUniversity of Health & Allied Sciences, School of Basic and Biomedical SciencesHoGhana
| | - Kofi M. Nyarko
- Disease Control and Prevention DepartmentGhana Health ServiceAccraGhana
| | - Ramatu Agambire
- Department of NursingGarden City University CollegeKumasiGhana
| | - Thomas O. Konney
- School of Medicine and DentistryKwame Nkrumah University of Science & Technology/Komfo Anokye Teaching HospitalKumasiGhana
| | - Joel Yarney
- National Centre for Radiotherapy and Nuclear MedicineKorle Bu Teaching HospitalAccraGhana
| | - Nelson Damale
- Department of Obstetrics and GynaecologyKorle Bu Teaching HospitalAccraGhana
| | - Brian Cox
- Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social MedicineDunedin School of Medicine, University of OtagoDunedinNew Zealand
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Emerson A, Dogan M, Hawes E, Wilson K, Chana SM, Kelly PJ, Comfort M, Ramaswamy M. Cervical cancer screening barriers and facilitators from the perspectives of women with a history of criminal-legal system involvement and substance use. HEALTH & JUSTICE 2024; 12:9. [PMID: 38407688 PMCID: PMC10895855 DOI: 10.1186/s40352-024-00262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The wide availability of routine screening with Papanicolaou (Pap) tests and vaccinations against human papillomavirus has resulted in a decline in rates of cervical cancer. As with other diseases, however, disparities in incidence and mortality persist. Cervical cancer, is found more often, at later stages, and has worse outcomes in people who live in rural areas, identify as Black or Hispanic, and in people who are incarcerated. Studies report 4-5 times higher rates of cervical cancer incidence in people detained in jails and prisons than in community-based samples. Studies to explain cervical cancer differences have been inconclusive, though there is broad consensus that issues of access play a role. In this study, we sought to learn more from people who have a history of criminal-legal system involvement and substance use about what barriers and facilitators they perceive in accessing cervical cancer preventive health and other support services in the community. RESULTS We conducted semi-structured interviews with open-ended questions by telephone with 20 self-identified women, ages 22-58, in Birmingham, Alabama. Interviews were audio recorded and transcribed and the transcripts analyzed using immersion-crystallization techniques. Our team identified two main themes, making connections: the importance of interpersonal communication, which stressed barriers and facilitators related to what makes for effective and humanistic interactions in cervical health prevention and other services, and getting it done: the logistics of access and availability, which highlighted elements of cost and payment; scheduling; transportation; and clinic policies. CONCLUSIONS People with a history of criminal-legal system involvement and substance abuse meet with a variety of enabling and impeding factors at personal and interpersonal as well as systemic levels in obtaining cervical health services. To better ensure that women in this high-risk group have equitable access to cervical cancer prevention and treatment-and thus better cancer outcomes-will require multilevel efforts that include an emphasis on improving the human connection in health care encounters and improving the nuts-and-bolts logistics related to accessing that care.
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Affiliation(s)
- Amanda Emerson
- KU School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66180, USA.
| | - Marissa Dogan
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Elizabeth Hawes
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Kiana Wilson
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Sofía Mildrum Chana
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Patricia J Kelly
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, 19107, USA
| | | | - Megha Ramaswamy
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66106, USA
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Christensen K, Bauer AG, Burgin T, Williams J, McDowd J, Sutkin G, Bennett K, Bowe Thompson C, Berkley-Patton JY. "Black Women Don't Always Put Our Healthcare First": Facilitators and Barriers to Cervical Cancer Screening and Perceptions of Human Papillomavirus Self-Testing Among Church-Affiliated African American Women. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:137-150. [PMID: 36125430 DOI: 10.1177/0272684x221115494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: African American women are at greater risk for cervical cancer incidence and mortality than White women. Up to 90% of cervical cancers are caused by human papillomavirus (HPVs) infections. The National Institutes of Health (NIH) co-developed HPV self-test kits to increase access to screening, which may be critical for underserved populations. Purpose/Research Design: This mixed methods study used the Theory of Planned Behavior to examine attitudes, barriers, facilitators, and intentions related to receipt of cervical cancer screening and perceptions of HPV self-testing among church-affiliated African American women. Study Sample/Data Collection: Participants (N = 35) aged 25-53 participated in focus groups and completed a survey. Results: Seventy-four percent of participants reported receipt of cervical cancer screening in the past 3 years. Healthcare providers and the church were supportive referents of screening. Past trauma and prioritizing children's healthcare needs were screening barriers. Concerns about HPV self-testing included proper test administration and result accuracy. Conclusions: Strategies to mitigate these concerns (e.g., delivering HPV self-test kits to the health department) are discussed.
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Affiliation(s)
- Kelsey Christensen
- Department of Family and Community Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Alexandria G Bauer
- Center for Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
| | - Tacia Burgin
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Joah Williams
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Joan McDowd
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Gary Sutkin
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kymberly Bennett
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Carole Bowe Thompson
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jannette Y Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
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Cooley-Strickland M, Wyatt GE, Loeb TB, Nicholas LA, Smith-Clapham A, Hamman A, Abraham M, Scott EN, Albarran G. Need for Sexual, Reproductive, and Mental Health Promotion Among Diverse College Students in a COVID-19 Era. Clin Child Fam Psychol Rev 2023; 26:1077-1096. [PMID: 37934361 PMCID: PMC10640429 DOI: 10.1007/s10567-023-00460-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/08/2023]
Abstract
In 2020, the COVID-19 pandemic forced unprecedented disruptions in higher education operations. While the adverse mental health effects experienced by college students due to these changes are well documented, less is known about the impact on their sexual and reproductive health (SRH), and the reciprocal relationships between SRH and mental health among adolescents and emerging adults. This position paper reviews existing literature on the effects of the COVID-19 pandemic on SRH, sexual violence, unintended pregnancy, sexually transmitted illness and human immunodeficiency virus rates and highlights issues specific to college-aged males, females, racial/ethnic and sexual minorities, and individuals with disabilities. The need to conceptualize SRH as an integral component of normal development, overall health, and well-being in the context of COVID-19 is discussed. The need to prioritize the design and implementation of developmentally appropriate, evidence-based SRH interventions specifically targeting college students is identified. Furthermore, an intergenerational approach to SRH that includes parents/caregivers and/or college faculty and staff (e.g., coaches, trainers) could facilitate comprehensive SRH prevention programming that enhances sexual violence prevention training programs currently mandated by many colleges. Policies and programs designed to mitigate adverse pandemic-related exacerbations in negative SRH outcomes are urgently needed and should be included in mainstream clinical psychology, not only focused on preventing unwanted outcomes but also in promoting rewarding interpersonal relationships and overall well-being. Recommendations for clinical psychologists and mental health researchers are made.
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Affiliation(s)
- Michele Cooley-Strickland
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA.
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Gail E Wyatt
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Tamra Burns Loeb
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Lisa A Nicholas
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amber Smith-Clapham
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Amina Hamman
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Misha Abraham
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Enricka Norwood Scott
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Graciela Albarran
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
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Summey R, Benoit M, Williams-Brown MY. Survival differences by race and surgical approach in early-stage operable cervical Cancer. Gynecol Oncol 2023; 179:63-69. [PMID: 37926048 DOI: 10.1016/j.ygyno.2023.10.015] [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: 07/06/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To evaluate if the higher rate of open radical hysterectomy in Black patients, prior to the widespread return to open surgical techniques, mitigated survival disparities and to identify other actionable factors to target for systemic change. METHODS This is a retrospective cohort study including patients from the National Cancer Database with cervical cancer who underwent radical hysterectomy from 2010 to 2018. Patient demographics, clinical characteristics and survival were compared by race and surgical route. Kaplan-Meier plots were constructed. Cox proportional hazards modeling was used to adjust for covariates. RESULTS 7201 patients were eligible for inclusion, 687 (9.5%) Black and 4870 (68%) White. We found that 51% of Black patients and 39% of White patients underwent open surgery. Black patients were 10% less likely to receive Guideline Concordant Care (GCC). Those with publicly-funded insurance had a 40% higher hazard of death compared to private insurance (CI 1.19-1.73 p < 0.001). Black patients who had open surgery had similar 5-year survival compared to White patients who had MIS surgery (0.90 vs 0.91, NS). After adjusting for potential confounders including age, insurance, nodal status, and lymphovascular space invasion, Black patients who had surgery had a 40% higher hazard for death (HR 1.40 95% CI 1.10-1.79, p = 0.007) compared to White patients. CONCLUSIONS A lower 5 and 10-year survival was seen in Black patients, regardless of surgical approach. Adjustment for significant covariates did not resolve this disparity, confirming that these factors do not fully account racial disparities.
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Affiliation(s)
- Rebekah Summey
- Department of Obstetrics and Gynecology at the Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | | | - M Yvette Williams-Brown
- Department of Obstetrics and Gynecology at the Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; Department of Women's Health at the University of Texas at Austin Dell Medical School, 1301 W 38(th) St., Suite 705, Austin, TX 78705, USA.
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Long ME, Lee YS, Vegunta S. Cervical cancer screening in menopause: when is it safe to exit? Menopause 2023; 30:972-979. [PMID: 37527477 DOI: 10.1097/gme.0000000000002222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
IMPORTANCE AND OBJECTIVE Despite a decreasing incidence of cervical cancer in North America overall, disparities in screening and cervical cancer rates persist, especially in the postmenopausal age group. METHODS We reviewed the literature regarding cervical cancer screening considerations for postmenopausal persons, with a focus on cervical cancer in postmenopausal persons, existing guidelines, screening methods, and gaps in care. DISCUSSION AND CONCLUSION Postmenopausal persons are an important population at risk because age 65 years in the United States and up to 70 years in some parts of Canada is a milestone for screening cessation if the criteria are met. Unfortunately, inadequate screening is common, with most women 65 years or older discontinuing ( exiting ) screening despite not meeting the criteria to do so. Screening cessation recommendations are nuanced, and if not all criteria are met, screening should be continued until they are. Cervical cancer screening should be stopped at the recommended age if adequate screening has occurred or at any age if life expectancy is limited or the patient has had a hysterectomy in the absence of high-grade preinvasive cervical lesions or cervical cancer. Human papillomavirus infection, which is causally linked to almost all cervical cancer cases, can persist or reactivate from a prior infection or can be newly acquired from sexual contact. With more persons aging with a cervix in place, the potential for cervical cancer has increased, and higher cancer rates may be observed if recommended screening is not adhered to. We propose an algorithm based on current cervical cancer screening guidelines to aid providers in identifying whether exit criteria have been met. Until adequate screening has been confirmed, cervical cancer screening should continue.
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Affiliation(s)
- Margaret E Long
- From the Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Yeonsoo S Lee
- Student, Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Scottsdale, AZ
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
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Kulkarni A, Chen L, Gockley A, Khoury-Collado F, Hou J, Clair CST, Melamed A, Hershman DL, Wright JD. Patterns of cervical cancer screening follow-up in the era of prolonged screening intervals. Gynecol Oncol 2023; 175:53-59. [PMID: 37327539 DOI: 10.1016/j.ygyno.2023.06.007] [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: 06/17/2022] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Little is known as to how prolonged screening recommendations for cervical cancer have affected compliance. OBJECTIVE We examined compliance with repeat cervical cancer screening among U.S. women aged 30-64 who underwent index screening between 2013 and 2019. STUDY DESIGN The IBM Watson Health MarketScan Database was used to identify commercially-insured women 30-64 years old who underwent cervical cancer screening from 2013 to 2019. The cohort was limited to women with continuous insurance 12 months before and ≥ 2 months after index testing. Patients with prior hysterectomy, more frequent surveillance needs, or a history of abnormal cytology, histology, or HPV test were excluded. Index screening included cytology, co-testing, or primary HPV testing. Cumulative incidence curves described screening intervals. Compliance was considered if repeat screening occurred 2.5-4 years after index cytology and 4.5-6 years after index co-testing. Cause-specific hazard models examined factors associated with compliance. RESULTS Of 5,368,713 patients identified, co-testing was performed in 2,873,070 (53.5%), cytology in 2,422,480 (45.1%), and primary HPV testing in 73,163 (1.4%). The cumulative incidence of repeat screening among all women by seven years was 81.9%. Of those who underwent repeat screening, 85.7% with index cytology and 96.6% with index co-testing were rescreened early. Only, 12.2% with index cytology had appropriate rescreening and 2.1% had delayed rescreening. Among the index co-testing group, 3.2% had appropriate rescreening and 0.3% had delayed rescreening. CONCLUSION Appropriate cervical cancer follow-up screening is highly variable. The cumulative incidence rate of repeat screening was 81.9% and among women rescreened, the vast majority are tested earlier than recommended by current guidelines.
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Affiliation(s)
- Amita Kulkarni
- Columbia University College of Physicians and Surgeons, USA
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, USA
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - June Hou
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Caryn S T Clair
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA; Joseph L. Mailman School of Public Health, Columbia University, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA.
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Duska LR. Overcoming disparities to improve cancer care: The story of cervical cancer. Cancer 2022; 128:4052-4054. [PMID: 36239012 DOI: 10.1002/cncr.34488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Effective screening and vaccination programs can potentially eliminate cervical cancer in the future; however, to accomplish this goal, we have to be able to offer services to all girls and women. In particular, women who live in rural areas and women who have low socioeconomic status are at highest risk. Efforts are required to improve access to care at all levels for these women at risk.
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Affiliation(s)
- Linda R Duska
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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10
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Emergency Contraception: Access and Challenges at Times of Uncertainty. Am J Ther 2022; 29:e553-e567. [PMID: 35998109 DOI: 10.1097/mjt.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The UN Commission on Life-Saving Commodities for Women's and Children's Health identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation. AREAS OF UNCERTAINTY Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access. DATA SOURCES PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization, The United Nations. THERAPEUTIC ADVANCES A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device. CONCLUSIONS EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.
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Schrier E, Holt HK, Kuppermann M, Sawaya GF. Changing Preferences for a Cervical Cancer Screening Strategy: Moving Away from Annual Testing. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:709-717. [PMID: 36147829 PMCID: PMC9436266 DOI: 10.1089/whr.2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/12/2022]
Abstract
Background While annual cytology has not been recommended for many years, it remains many patients' preferred screening strategy for cervical cancer. Patient education and provider recommendations have been found effective in aligning professional society guidelines with patient preferences. We assessed whether an educational video with value elicitation exercises (utility assessments) changed screening strategy preferences among patients who had an initial preference for annual screening. Materials and Methods We conducted an interventional study of English- or Spanish-speaking women 21-65 years of age, recruited from two women's health clinics in San Francisco, California (n = 262). Participants were asked about their preferred method of screening before viewing a 7-minute educational video and using a computerized tool that elicited values for 23 different health states related to cervical cancer screening. Directly afterward, they were again asked about their preferred screening strategy. Multivariable regression analysis was utilized to identify independent predictors of changing preferences. Results Of 246 enrollees, 62.6% (154/246) had an initial preference for annual cytology; after viewing the video and completing the values elicitation exercises, about half (72/154, 47%) preferred a strategy other than annual screening. Having attended college and being screened every 3 to 5 years in the recent past were independent predictors of changing preferences away from annual screening. In sensitivity analyses, 53.2% of average-risk participants changed preferences away from annual cytology (p < 0.01). Conclusions Viewing an educational video and conducting a series of value elicitation exercises were associated with a substantially decreased likelihood of preferring annual screening. These findings underscore the importance of patient-centered education to help support informed patient preferences.
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Affiliation(s)
- Elizabeth Schrier
- School of Medicine, University of California, San Francisco, San Francisco, California, USA.,Address correspondence to: Elizabeth Schrier, BA, School of Medicine, University of California, San Francisco, San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Hunter K. Holt
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Family and Community Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - George F. Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA.,Center for Healthcare Value, University of California, San Francisco, San Francisco, California, USA
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12
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Cherston C, Yoh K, Huang Y, Melamed A, Gamble CR, Prabhu VS, Li Y, Hershman DL, Wright JD. Relative importance of individual insurance status and hospital payer mix on survival for women with cervical cancer. Gynecol Oncol 2022; 166:552-560. [PMID: 35787803 DOI: 10.1016/j.ygyno.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the relative contributions of individual insurance status and hospital payer mix (safety net status) to quality of care and survival for patients with cervical cancer. METHODS We used the National Cancer Database to identify patients with cervical cancer diagnosed from 2004 to 2017. Patients were classified by insurance (uninsured/Medicaid/private/Medicare/other) and hospitals were grouped into quartiles based on the proportion of uninsured/Medicaid patients (payer mix) (top quartile defined as safety-net hospital (SNHs) and lowest as Q1 hospitals). Quality-of-care was assessed by adherence to evidence-based metrics. Individual contributions of insurance status and payer mix to survival was assessed with a proportional hazards Cox model. RESULTS A total of 124,339 patients including 11,338 uninsured (9.1%) and 27,281 Medicaid (21.9%) recipients treated at 1156 hospitals were identified. Quality-of-care was not significantly different across hospital quartiles. Adjusting for patients' clinical/demographic characteristics, treatment at a SNH was associated with a 14% higher mortality (HR = 1.14; 95% CL, 1.08-1.20) than at Q1 hospitals. Testing for individual insurance, uninsured patients had 32% increased mortality (HR = 1.32; 95% CI,1.26-1.38) and Medicaid recipients 40% increased (HR = 1.40; 95%CI,1.35-1.44) compared to privately insured patients. Examining both payer mix and insurance, only individual insurance retained a significant impact on mortality. CONCLUSIONS Individual insurance may be a more important predictor of survival than site-of-care and hospital payer mix for women with cervical cancer. There is substantial variation in outcomes within hospitals based on individual insurance, regardless of hospital payer mix.
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Affiliation(s)
- Caroline Cherston
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Katherine Yoh
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Yongmei Huang
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Alexander Melamed
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Charlotte R Gamble
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | | | - Yeran Li
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Dawn L Hershman
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Jason D Wright
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA.
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13
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Kontomanolis EN, Koutras A, Fasoulakis Z, Syllaios A, Diakosavvas M, Angelou K, Symeonidis P, Samara AA, Pergialiotis V, Garmpis N, Schizas D, Pagkalos A, Chionis A, Daskalakis G, Ntounis T. A Brief Overview of Oncogenes and Signal Transduction Pathways in Gynecological Cancer. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:134-143. [PMID: 35399174 PMCID: PMC8962808 DOI: 10.21873/cdp.10087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
Gynecological cancer is the cancer that originates in the female reproductive system. According to the anatomical location of the cancer, it is distinguished into cervical, uterine, vaginal, ovarian, and vulvar cancer. Oncogenes and tumor catalytic genes play a key role in the genesis and development of gynecological cancer. This article presents the signaling pathways and expression of oncogenes that take place in the carcinogenesis of the female reproductive system.
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Affiliation(s)
- Emmanuel N Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Antonios Koutras
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Zacharias Fasoulakis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Athanasios Syllaios
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Michail Diakosavvas
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Kyveli Angelou
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | | | - Athina A Samara
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Vasilios Pergialiotis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Nikolaos Garmpis
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Athanasios Pagkalos
- Department of Obstetrics and Gynecology, General Hospital of Xanthi, Xanthi, Greece
| | - Athanasios Chionis
- Department of Obstetrics and Gynecology, Laiko General Hospital of Athens, Athens, Greece
| | - Georgios Daskalakis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Thomas Ntounis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
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14
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Chukwueke UN, Hervey-Jumper S, Porter A. Disparities and Inequities Among Patients with Central Nervous System Tumor. Hematol Oncol Clin North Am 2021; 36:e1-e8. [PMID: 34801164 DOI: 10.1016/j.hoc.2021.10.002] [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] [Indexed: 11/16/2022]
Abstract
Since the 2002 Institute of Medicine report, which many cite as a landmark in first defining and calling attention to the concept of health disparities in medicine, much work has been dedicated to characterizing health disparities in medical care with the aim of eliminating them. Importantly, this report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," laid bare the differences in quality of health care that are based on race, ethnicity, and socioeconomic status. Here, the authors elaborate on these issues and discuss the role of the neuro-oncologic workforce in potentially mitigating these disparities.
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Affiliation(s)
- Ugonma N Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco and Weill Institute for Neurosciences, 513 parnassus avenue, health science suite 814, San Francisco, CA 94143, USA
| | - Alyx Porter
- Department of Neurology, Mayo Clinic Cancer Center, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA
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15
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Ortiz AP, Soto-Salgado M, Calo WA, Hull P, Fernández ME, Colon-López V, Tortolero-Luna G. Elimination of cervical cancer in U.S. Hispanic populations: Puerto Rico as a case study. Prev Med 2021; 144:106336. [PMID: 33678233 DOI: 10.1016/j.ypmed.2020.106336] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022]
Abstract
Cervical cancer remains a major burden for women around the world. In 2018, the World Health Organization called for the elimination of cervical cancer worldwide (<4 cases per 100,000 women-years), within the 21st century. In the U.S., despite great progress toward this goal, existing disparities among racial/ethnic groups in cervical cancer raise concerns about whether elimination can be achieved for all women. We describe: 1) disparities in cervical cancer among Hispanics in the U.S. and factors that contribute to their increased risk, 2) prevention and control efforts to increase equity in the elimination of cervical cancer in this population, and 3) cervical cancer control efforts in Puerto Rico (PR), a U.S. territory, as a case study for cervical cancer elimination among a minority and underserved Hispanic population. Hispanics have the highest incidence rates of cervical cancer among all racial/ethnic groups in the U.S. Despite being more likely to complete HPV vaccination series, lower cervical cancer screening and access to treatment may lead to a higher cervical cancer mortality in Hispanics compared to non-Hispanic White women. These disparities are influenced by multiple individual-, sociocultural-, and system-level factors. To achieve the goal of cervical cancer elimination in the U.S., systematic elimination plans that consider the needs of Hispanic populations should be included within the Comprehensive Cancer Control Plans of each state. Because PR has implemented coordinated efforts for the prevention and control of cervical cancer, it represents a notable case study for examining strategies that can lead to cervical cancer elimination among Hispanics.
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Affiliation(s)
- Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America.
| | - Marievelisse Soto-Salgado
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America; Department of Biochemistry, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Pamela Hull
- University of Kentucky Markey Cancer Center, United States of America; Department of Behavioral Science, University of Kentucky College of Medicine, United States of America
| | - María E Fernández
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, TX, United States of America
| | - Vivian Colon-López
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Guillermo Tortolero-Luna
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America
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16
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Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, Guerra CE, Oeffinger KC, Shih YCT, Walter LC, Kim JJ, Andrews KS, DeSantis CE, Fedewa SA, Manassaram-Baptiste D, Saslow D, Wender RC, Smith RA. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin 2020; 70:321-346. [PMID: 32729638 DOI: 10.3322/caac.21628] [Citation(s) in RCA: 426] [Impact Index Per Article: 106.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022] Open
Abstract
The American Cancer Society (ACS) recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable) (strong recommendation). The ACS recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, discontinue all cervical cancer screening (qualified recommendation). These new screening recommendations differ in 4 important respects compared with the 2012 recommendations: 1) The preferred screening strategy is primary HPV testing every 5 years, with cotesting and cytology alone acceptable where access to US Food and Drug Administration-approved primary HPV testing is not yet available; 2) the recommended age to start screening is 25 years rather than 21 years; 3) primary HPV testing, as well as cotesting or cytology alone when primary testing is not available, is recommended starting at age 25 years rather than age 30 years; and 4) the guideline is transitional, ie, options for screening with cotesting or cytology alone are provided but should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers. Evidence related to other relevant issues was reviewed, and no changes were made to recommendations for screening intervals, age or criteria for screening cessation, screening based on vaccination status, or screening after hysterectomy. Follow-up for individuals who screen positive for HPV and/or cytology should be in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors.
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Affiliation(s)
| | - Andrew M D Wolf
- Division of General Medicine, Geriatrics, and Palliative Care, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Timothy R Church
- Division of Environmental Health Sciences, University of Minnesota School of Public Health and Masonic Cancer Center, Minneapolis, Minneapolis
| | - Ruth Etzioni
- Public Health Sciences Division, the Fred Hutchinson Cancer Research Center, Seattle, Washington
- Biostatistics, University of Washington Seattle, Seattle, Washington
| | - Christopher R Flowers
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abbe Herzig
- University of Albany School of Public Health, Albany, New York
| | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Kevin C Oeffinger
- Duke Cancer Institute Center for Onco-Primary Care, Durham, North Carolina
| | - Ya-Chen Tina Shih
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Louise C Walter
- Division of Geriatrics, University of California-San Francisco, San Francisco, California
- Division of Geriatrics, San Francisco VA Health Care System, San Francisco, California
| | - Jane J Kim
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kimberly S Andrews
- Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia
| | - Carol E DeSantis
- Surveillance Research, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Surveillance Research, American Cancer Society, Atlanta, Georgia
| | | | - Debbie Saslow
- Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia
| | - Richard C Wender
- Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert A Smith
- Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia
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17
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Patel SN, Staples JN, Garcia C, Chatfield L, Ferriss JS, Duska L. Are ethnic and racial minority women less likely to participate in clinical trials? Gynecol Oncol 2020; 157:323-328. [PMID: 32253046 DOI: 10.1016/j.ygyno.2020.01.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Given the disparity that exists in enrollment of minorities to oncology clinical trials, the objective of our study was to assess whether race is associated with willingness to participate in gynecologic oncology clinical trials in a rural Southern academic medicine setting. Our secondary aim was to determine whether willingness to participate is impacted by an educational intervention. METHODS A single institution prospective survey study was performed at an academic medical center. Women presenting to the gynecologic oncology clinic with a current or prior diagnosis of gynecologic malignancy were approached to participate. The validated Attitudes to Randomized Trials Questionnaire (ARTQ) assessed willingness to participate in clinical trials. Relevant demographic and clinical data were abstracted. Characteristics were compared between those willing and unwilling to participate in clinical trials with a chi-square test for categorical variables and Wilcoxon rank sum tests for continuous data. RESULTS We enrolled 156 participants (50% White, 50% non-White) from May 2017 to January 2018. The minority group included 35% non-Hispanic Black, 9% Hispanic, 4% Asian, and 2% other. Median age was 63 years with endometrial cancer being the most common diagnosis (48%). On initial screen, only 35% were willing to participate in a clinical trial. Willingness to participate did not differ between race, age, marital status, education level, cancer type, stage, or mode of treatment. Rates improved to 82% after being provided additional educational information. Following education, White women and those with more education were significantly more willing to participate in clinical trials than their minority and less educated counterparts. CONCLUSIONS Willingness to participate improved among all sub-categories following an educational intervention. The increase in willingness was less robust among racial and ethnic minorities, suggesting that different tools are needed for recruitment of minorities to gynecologic oncology clinical trials.
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Affiliation(s)
- Shweta N Patel
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jeanine N Staples
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States of America.
| | - Christine Garcia
- Division of Gynecologic Oncology, The Permanente Medical Group, Kaiser Northern California, San Francisco, CA, United States of America
| | - Lindsay Chatfield
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Washington, DC, United States of America
| | - J Stuart Ferriss
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Linda Duska
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States of America
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18
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Lee EQ, Chukwueke UN, Hervey-Jumper SL, de Groot JF, Leone JP, Armstrong TS, Chang SM, Arons D, Oliver K, Verble K, Musella A, Willmarth N, Alexander BM, Bates A, Doherty L, Galanis E, Gaffey S, Halkin T, Friday BE, Fouladi M, Lin NU, Macdonald D, Mehta MP, Penas-Prado M, Vogelbaum MA, Sahebjam S, Sandak D, van den Bent M, Weller M, Reardon DA, Wen PY. Barriers to accrual and enrollment in brain tumor trials. Neuro Oncol 2019; 21:1100-1117. [PMID: 31175826 PMCID: PMC7594546 DOI: 10.1093/neuonc/noz104] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Many factors contribute to the poor survival of malignant brain tumor patients, some of which are not easily remedied. However, one contributor to the lack of progress that may be modifiable is poor clinical trial accrual. Surveys of brain tumor patients and neuro-oncology providers suggest that clinicians do a poor job of discussing clinical trials with patients and referring patients for clinical trials. Yet, data from the Cancer Action Network of the American Cancer Society suggest that most eligible oncology patients asked to enroll on a clinical trial will agree to do so. To this end, the Society for Neuro-Oncology (SNO) in collaboration with the Response Assessment in Neuro-Oncology (RANO) Working Group, patient advocacy groups, clinical trial cooperative groups, including the Adult Brain Tumor Consortium (ABTC), and other partners are working together with the intent to double clinical trial accrual over the next 5 years. Here we describe the factors contributing to poor clinical trial accrual in neuro-oncology and offer possible solutions.
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Affiliation(s)
- Eudocia Q Lee
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ugonma N Chukwueke
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Jose Pablo Leone
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan M Chang
- University of California San Francisco, San Francisco, California, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, Surrey, UK
| | - Kay Verble
- The Sontag Foundation and Brain Tumor Network, Ponte Vedre Beach, Florida, USA
| | - Al Musella
- The Musella Foundation for Brain Tumor Research and Information, Hewlett, New York, USA
| | | | | | - Amanda Bates
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Lisa Doherty
- National Brain Tumor Society, Newton, Massachusetts, USA
| | | | - Sarah Gaffey
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thomas Halkin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Maryam Fouladi
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nancy U Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - David Sandak
- Accelerate Brain Cancer Cure (ABC2), Washington, DC, USA
| | | | - Michael Weller
- University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Patrick Y Wen
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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19
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Olusola P, Ousley K, Ndetan H, Singh KP, Banerjee HN, Dasgupta S. Cervical Cancer Prevention in Racially Disparate Rural Populations. MEDICINES (BASEL, SWITZERLAND) 2019; 6:medicines6030093. [PMID: 31487904 PMCID: PMC6789706 DOI: 10.3390/medicines6030093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/27/2019] [Accepted: 08/31/2019] [Indexed: 06/10/2023]
Abstract
Background: Undergoing a timely Pap smear, high-risk human papilloma virus (HPV)- and colposcopy-based testing can reduce HPV-associated cervical cancer (CC) development in women. However, in rural areas, women and minorities without insurance do not undergo periodic assessment and remain at greater risk of HPV infection and CC. Methods: In this study, 173 women from rural East Texas with various ethnic backgrounds were examined thorough HPV/Pap-based testing and colposcopic assessment. Results: Of the 113 informative cases, 77% (87/113) were positive for high-risk HPV infection and 23% of subjects (26/113) were negative. Associations between HPV positivity with young age (p = 0.002), and a low number of pregnancy (p = 0.004) and births (p = 0.005) were evident. Women with long-term use of contraceptives (OR 1.93, 95% CI, 0.80-4.69) were associated with increased risk of HPV infection. African-American women had a higher risk of abnormal Pap outcome compared to Caucasians (OR 5.31, 95% CI, 0.67-42.0). HPV seemed to be a predictor of abnormal Pap outcome (OR 1.77, 95% CI, 0.48-6.44) in these subjects. Unmarried/widowed/divorced women had an increased abnormal Pap test outcome compared to married women or women living with a partner (p = 0.01), with over 278% increased odds (OR 3.78 at 95% CI, 1.29-11.10). Insured women undergoing periodic checkups were detected early with high-risk HPV infection and abnormal Pap test/colposcopic outcome. Conclusions: Comprehensive and timely screening of uninsured women and minorities in rural East Texas are warranted, which could potentially prevent the onset of HPV-associated CC.
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Affiliation(s)
- Patti Olusola
- Department of Family Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
| | - Kia Ousley
- Department of Family Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
| | - Harrison Ndetan
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
| | - Karan P Singh
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
| | - Hirendra Nath Banerjee
- Department of Natural, Pharmacy and Health Sciences, Elizabeth City State University, Elizabeth City, NC 27909, USA.
| | - Santanu Dasgupta
- Department of Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
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