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Acuti Martellucci C, Giacomini G, Flacco ME, Manzoli L, Morettini M, Martellucci M, Rosati S, Bizzarri S, Palmer M, Pascucci L, Uncini M, Pasqualini F. Effectiveness of tailored talks between a cancer screening specialist and general practitioners to improve the uptake of colorectal cancer screening in Ancona (Italy) during the pandemic period. Eur J Gen Pract 2024; 30:2340672. [PMID: 38618885 PMCID: PMC11020593 DOI: 10.1080/13814788.2024.2340672] [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: 03/18/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening uptake in many countries has been low and further impacted by the COVID-19 pandemic. General Practitioners (GPs) are key facilitators, however research on their impact on organised CRC screening is still limited. OBJECTIVES To evaluate the effectiveness of tailored talks with GPs to increase population uptake of the long-established CRC screening programme in Ancona province, Italy. METHODS In this prospective cohort study, one-to-one tailored talks were organised in January 2020 between the GPs of one county of the province (with GPs from other counties as controls) and the screening programme physician-in-chief to discuss the deployment and effectiveness of organised screening. Data was extracted from the National Healthcare System datasets and linear regression was used to assess the potential predictors of CRC screening uptake. RESULTS The mean CRC screening uptake remained stable from 39.9% in 2018-19 to 40.8% in 2020-21 in the 22 GPs of the intervention county, whereas it statistically significantly decreased from 38.7% to 34.7% in the 232 control GPs. In multivariate analyses, belonging to the intervention county was associated with an improved uptake compared to the control counties (+5.1%; 95% Confidence Intervals - CI: 2.0%; 8.1%). CONCLUSION Persons cared for by GPs who received a tailored talk with a cancer screening specialist avoided a drop in CRC screening adherence, which characterised all other Italian screening programmes during the COVID-19 emergency. If future randomised trials confirm the impact of tailored talks, they may be incorporated into existing strategies to improve population CRC screening uptake.
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Affiliation(s)
| | - Giusi Giacomini
- Oncologic Screening Unit, Ancona Healthcare Agency, Ancona, Italy
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Lamberto Manzoli
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | | | - Mosè Martellucci
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Sara Rosati
- Department of Biomedical Sciences and Public Health, University of the Marche Region, Ancona, Italy
| | - Silvia Bizzarri
- Department of Biomedical Sciences and Public Health, University of the Marche Region, Ancona, Italy
| | - Matthew Palmer
- The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Lidia Pascucci
- Department of Biomedical Sciences and Public Health, University of the Marche Region, Ancona, Italy
| | - Marco Uncini
- Department of Biomedical Sciences and Public Health, University of the Marche Region, Ancona, Italy
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Gram EJPN, Moseholm E, Nørløv AB, Wilken-Jensen C, Thorsteinsson K, Pedersen BT, Jørgensen SM, Bonde J, Omland LH, Lebech AM, Weis N. Cervical cancer screening integrated in routine clinical care of women with HIV. AIDS 2024; 38:1648-1657. [PMID: 38950190 DOI: 10.1097/qad.0000000000003972] [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: 07/03/2024]
Abstract
OBJECTIVE To evaluate if integrated cervical cancer screening (CCS) for women with HIV (WWH) in routine HIV care resulted in increased adherence to screening, and to describe the prevalence of human papillomavirus (HPV)-specific genotypes and the incidence of cellular abnormalities. DESIGN Cohort study. METHODS WWH who accepted the offer of combined CCS and HIV care (group 1), WWH who declined the offer (group 2), and WWH not offered CCS within HIV care (group 3) between 2013 and 2019 were included. Data was collected from The Danish HIV Cohort Study and The Danish Pathology Data Bank. Adherence to the CCS program was defined as fulfilled if WWH were screened annually. RESULTS A total of 804 WWH were included. WWH who accepted CCS within HIV care (group 1; n = 218) had significantly higher adherence to screening in all study years 22-99% compared with the WWH who declined CCS (group 2; n = 232) 10-16% and WWH who were not invited for CCS (group 3; n = 354) 11-25%. There was no significant difference in the prevalence of HPV-specific genotypes and incidence of cellular abnormalities among the three groups. CONCLUSION Integrating CCS for WWH in routine HIV care resulted in higher adherence to the CCS guidelines. Combined services thereby represent an opportunity to engage WWH in HIV care into preventive services.
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Affiliation(s)
- Emma J P N Gram
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
| | - Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Anne B Nørløv
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Hvidovre
| | | | - Kristina Thorsteinsson
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Bispebjerg
| | | | - Sussie M Jørgensen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
| | - Jesper Bonde
- Department of Pathology, Copenhagen University Hospital, Hvidovre
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Benjamin KA, Lamberti N, Cooke M. Predictors of non-adherence to cervical cancer screening among immigrant women in Ontario, Canada. Prev Med Rep 2023; 36:102524. [PMID: 38116269 PMCID: PMC10728462 DOI: 10.1016/j.pmedr.2023.102524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Cervical cancer is one of the most common types of cancer among women and is largely preventable with regular screening using Papanicolau (Pap) tests. In Canada, all provinces have regular screening programs, although with slightly differing recommendations. Previous research has found that immigrant women, who are a large proportion of the Canadian population, are at higher risk of being under-screened, or non-adherent to the recommended screening frequency. Using data from the 2017 Canadian Community Health Survey, this study examined: (1) the extent to which immigration status and time since immigration are associated with Pap test adherence in Ontario, and (2) predictors of Pap test adherence for immigrants and Canadian born populations in Ontario, Canada's most populous province, with a focus on the role of racial or ethnic identity among immigrants. Estimates of 3-year test adherence were 71.3 % (95 %CI: 66.9-75.7) among immigrant women and 75.4 % (95 %CI: 73.1-77.1) among non-immigrant women. Recent immigrants (6-10 years in Canada) had lower adherence (63.5 %, 95 %CI: 48.0-80.0). Logistic regression models found that immigrant women had lower adherence than Canadian-born women, controlling for age, household income, education, and having a primary care physician. Subgroup analysis found that South Asian immigrant women were least likely to be adherent. These results support targeted programming to increase screening adherence among recent immigrants and raise concerns regarding potential barriers to screening. Data that allow better disaggregation of racial and ethnic identities are important for better understanding the potential implications of these patterns for racial inequities in health.
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Affiliation(s)
- Kayla A. Benjamin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nina Lamberti
- Dalla Lana School of Public Health, University of Toronto, 155 College St 6th Floor, Toronto, ON M5T 3M6, Canada
| | - Martin Cooke
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G5, Canada
- Department of Sociology and Legal Studies, Faculty of Arts, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G5, Canada
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4
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The Role of Vaccination and Screening in Limiting the Worldwide Disease Burden of Preventable Female Cancers: A Review. WOMEN 2020. [DOI: 10.3390/women1010002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cancer represents one of the most common causes of death worldwide. Among women, breast cancer is the most diagnosed cancer and the principal cause of death due to malignant disease, while cervical cancer ranks fourth for both incidence and mortality. The present review aims to analyze the epidemiology of cervical and breast cancer (incidence, mortality, survival rates, and trends). Moreover, the most important primary and secondary preventive strategies (reduction of risk factors, exposure, vaccination, cancer screening) intended to reduce the future burden of cervical and breast cancer, that should be adopted actively and free of charge, were discussed in accordance to more recent and evidence-based findings.
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Veldhuis CB, Maki P, Molina K. Psychological and neighborhood factors associated with urban women's preventive care use. J Behav Med 2020; 43:346-364. [PMID: 31865485 PMCID: PMC7234927 DOI: 10.1007/s10865-019-00122-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
Women are more likely than men to forego care-including preventive care. Understanding which factors influence women's preventive care use has the potential to improve health. This study focuses on the largely understudied areas of psychological barriers (depression) and neighborhood factors (support and stressors) that may be associated with women's preventive care use through secondary analysis of the Chicago Community Adult Health Study. Across models, 30-40% of the variance in preventive care adherence was explained by the neighborhood. Depressive symptoms were not associated with preventive care use when neighborhood factors were included. However, stratified models showed that associations varied by race/ethnicity. Previous research has tended to focus on individual determinants of care, but this study suggests that barriers to care are far more complex. Efforts aimed at improving care utilization need to be multipronged and interventions need to take an individual's demographics, mental health, and context into account.
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Affiliation(s)
- Cindy B Veldhuis
- School of Nursing, Columbia University, New York, NY, USA.
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA.
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, IL, USA.
| | - Pauline Maki
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Kristine Molina
- Department of Psychology, University of California Irvine, Irvine, CA, USA
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Mignot S, Ringa V, Vigoureux S, Zins M, Panjo H, Saulnier PJ, Fritel X. Pap tests for cervical cancer screening test and contraception: analysis of data from the CONSTANCES cohort study. BMC Cancer 2019; 19:317. [PMID: 30952209 PMCID: PMC6451274 DOI: 10.1186/s12885-019-5477-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/14/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In France, a Pap test for cervical cancer screening is recommended every three years for all sexually active women aged 25 to 65 years. Modes of contraception (any or no contraception, with or without a visit to a physician, and with or without a gynecological examination) may influence adhesion to screening: women who use intrauterine device (IUD) should be more up to date with their cervical cancer screening more often than those using other means of contraception. Our objectives were to analyze the association between modes of contraception and Pap tests for screening. METHODS This cross sectional study is based on the CONSTANCES cohort enabled us to include 16,764 women aged 25-50 years. The factors associated with adhesion to cervical cancer screening (defined by a report of a Pap test within the previous 3 years) was modeled by logistic regression. Missing data were imputed by using multiple imputations. The multivariate analyses were adjusted for sex life, social and demographic characteristics, and health status. RESULTS Overall, 11.2% (1875) of the women reported that they were overdue for Pap test screening. In the multivariate analysis there was no significant difference between women using an IUD and those pills or implant of pap test overdue ORa:0.9 CI95% [0.8-1.1], ORa 1.3 CI95% [0.7-2.7] respectively. Women not using contraceptives and those using non-medical contraceptives (condoms, spermicides, etc.) were overdue more often ORa: 2.6 CI95% [2.2-3.0] and ORa: 1.8 CI95% [1.6-2.1] respectively than those using an IUD. CONCLUSION Women seeing medical professionals for contraception are more likely to have Pap tests.
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Affiliation(s)
- Stéphanie Mignot
- Department of General Practice, University of Poitiers, France: 3 rue de la Milétrie, 86000 Poitiers, France
| | - Virginie Ringa
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
| | - Solène Vigoureux
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
- Ined, Paris, France
- Obstetrics & Gynecology Department, Hôpital Bicêtre, GHU Sud, AP-HP, Faculty of Medicine, University of Paris Sud, F-94276 Le Kremlin Bicêtre, France
| | - Marie Zins
- Epidemiological Population-Based Cohorts Unit, INSERM UMS 11, Villejuif, France
- University of Paris-Descartes, Paris, France
| | - Henri Panjo
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
- Ined, Paris, France
| | - Pierre-Jean Saulnier
- Clinical Research Centree CIC1402, INSERM, Department of Obstetrics, Gynecology, and Reproductive Medicine Poitiers University Hospital Centre, University of Poitiers, Poitiers, France
| | - Xavier Fritel
- Clinical Research Centree CIC1402, INSERM, Department of Obstetrics, Gynecology, and Reproductive Medicine Poitiers University Hospital Centre, University of Poitiers, Poitiers, France
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de Pokomandy A, Burchell AN, Salters K, Ding E, O'Brien N, Bakombo DM, Proulx-Boucher K, Boucoiran I, Pick N, Ogilvie G, Loutfy M, Kaida A. Cervical cancer screening among women living with HIV: a cross-sectional study using the baseline questionnaire data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). CMAJ Open 2019; 7:E217-E226. [PMID: 30979726 PMCID: PMC6461544 DOI: 10.9778/cmajo.20180151] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cisgender women with HIV experience an elevated risk of cervical cancer compared with HIV-negative women, but this cancer can be prevented through regular cervical cancer screening. Our study objective was to measure adherence to current national cervical cancer screening guidelines among women with HIV in 3 Canadian provinces and identify factors associated with delays. METHODS We conducted a cross-sectional study using the baseline questionnaire of the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Participants were recruited through clinics, peers and community organizations in British Columbia, Ontario and Quebec. Women were eligible for inclusion if they were cisgender female with HIV, aged 21-70 years, and never had cervicectomy/hysterectomy. RESULTS Of 1189 eligible participants, 815 (68.5%) had received cervical cancer screening less than 1 year ago (i.e., as recommended), 211 (17.7%) 1-3 years ago (i.e., moderate delay) and 163 (13.7%) at least 3 years ago or never (i.e., long delay). Overall, 309 (26.0%) had never discussed the need for a Papanicolaou smear with a nurse/doctor. Factors associated with a long delay were living in Ontario (adjusted odds ratio [OR] 2.51, 95% confidence interval [CI] 1.29-4.88) or Quebec (adjusted OR 3.70, 95% CI 1.79-7.67) (v. BC), being sexually inactive in the past 6 months (adjusted OR 2.02, 95% CI 1.25-3.25), having unknown or < 200 cells/mm3 CD4 counts (adjusted OR 1.78, 95% CI 1.11-2.85) and having a male HIV care provider (adjusted OR 2.15, 95% CI 1.36-3.42). INTERPRETATION Over one-third of women reported cervical cancer screening delays, and one-quarter had never discussed cervical cancer screening recommendations with a health care provider. Additional efforts are needed to improve women's and health care providers' awareness of cervical cancer screening recommendations, particularly among women who are sexually inactive, who are immunosuppressed and who have male HIV care providers.
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Affiliation(s)
- Alexandra de Pokomandy
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont.
| | - Ann N Burchell
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Kate Salters
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Erin Ding
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Nadia O'Brien
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Dada Mamvula Bakombo
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Karène Proulx-Boucher
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Isabelle Boucoiran
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Neora Pick
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Gina Ogilvie
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Mona Loutfy
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
| | - Angela Kaida
- Chronic Viral Illness Service (de Pokomandy, Bakombo, Proulx-Boucher), McGill University Health Centre; Department of Family Medicine (de Pokomandy, O'Brien), McGill University, Montréal, Que.; Department of Family and Community Medicine (Burchell), St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Salters, Kaida), Simon Fraser University, Burnaby, BC; BC Centre for Excellence in HIV/AIDS (Salters, Ding, Kaida), Vancouver, BC; Department of Obstetrics and Gynecology (Boucoiran), Hôpital Sainte-Justine and Université de Montréal, Montréal, Que.; Oak Tree Clinic (Pick), BC Women's Hospital; Department of Family Practice (Ogilvie), School of Population and Public Health, University of British Columbia, Vancouver, BC; Women's College Research Institute (Loutfy), Women's College Hospital; Faculty of Medicine (Loutfy), University of Toronto, Toronto, Ont
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Burchell AN, Kendall CE, Cheng SY, Lofters A, Cotterchio M, Bayoumi AM, Glazier RH, Antoniou T, Raboud J, Yudin MH, Loutfy M. Cervical cancer screening uptake among HIV-positive women in Ontario, Canada: A population-based retrospective cohort study. Prev Med 2018; 107:14-20. [PMID: 29197533 DOI: 10.1016/j.ypmed.2017.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/16/2017] [Accepted: 11/26/2017] [Indexed: 10/18/2022]
Abstract
Cervical cancer caused by oncogenic types of the human papillomavirus (HPV) is of concern among HIV-positive women due to impairment of immune responses required to control HPV infection. Our objectives were to describe patterns of cervical cancer screening using Pap cytology testing among HIV-positive women in Ontario, Canada from 2008 to 2013 and to identify factors associated with adequate screening. We conducted a retrospective, population-based cohort study among screen-eligible HIV-positive women using provincial administrative health data. We estimated annual proportions tested and reported these with 95% confidence intervals (CI). Next, using person-years as the unit of analysis, we identified factors associated with annual Pap testing using log-binomial regression. A total of 2271 women were followed over 10,697 person-years. In 2008, 34.0% (95%CI 31.1-37.0%) had a Pap test. By 2013, the proportion of HIV-positive women tested was 25.9% (95%CI 23.6-28.2%). Women who were most likely to undergo testing were younger, were immigrants from countries with generalized HIV epidemics, lived in the highest income neighbourhoods, had a female primary care physician, had two or more encounters per year with an infectious disease or internal medicine specialist, and had greater comorbidity. Nearly three in four HIV-positive women were under-screened despite all having universal insurance for medically-necessary services. Annual Pap testing decreased following the 2011-2013 release of new guidelines for a lengthened screen interval for average risk women and a billing disincentive. Clinic-based intervention such as physician alerts or reminders may be needed to improve screening coverage among HIV-positive women.
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Affiliation(s)
- Ann N Burchell
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Claire E Kendall
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Stephanie Y Cheng
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Michelle Cotterchio
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Glazier
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tony Antoniou
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mark H Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mona Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Pedersen K, Burger EA, Campbell S, Nygård M, Aas E, Lönnberg S. Advancing the evaluation of cervical cancer screening: development and application of a longitudinal adherence metric. Eur J Public Health 2017; 27:1089-1094. [DOI: 10.1093/eurpub/ckx073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Chubak J, Hubbard R. Defining and measuring adherence to cancer screening. J Med Screen 2016; 23:179-185. [PMID: 26946420 PMCID: PMC5011024 DOI: 10.1177/0969141316630766] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The importance of cancer screening is well-recognized, yet there is great variation in how adherence is defined and measured. This manuscript identifies measures of screening adherence and discusses how to estimate them. DISCUSSION We begin by describing why screening adherence is of interest: to anticipate long-term outcomes, to understand differences in outcomes across settings, and to identify areas for improvement. We outline questions of interest related to adherence, including questions about uptake, currency or being up-to-date, and longitudinal adherence, and then identify which measures are most appropriate for each question. Our discussion of how to select measures focuses on study inclusion criteria and outcome definitions. Finally, we describe how to estimate different measures using data from two common data sources: survey studies and surveillance studies. Estimation requires consideration of data sources, inclusion criteria, and outcome definitions. Censoring often will be present and must be accounted for. CONCLUSION We conclude that consistent definitions and estimation of adherence to cancer screening guidelines will facilitate comparison across studies, tests, and settings, and help to elucidate areas for future research and intervention.
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Affiliation(s)
- Jessica Chubak
- Group Health Research Institute, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Rebecca Hubbard
- Department of Biostatistics & Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
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Urrutia MT, Araya A, Jaque MF. Why Do Chilean Women Choose to Have or Not Have Pap Tests? J Obstet Gynecol Neonatal Nurs 2016; 46:e3-e12. [PMID: 27886949 DOI: 10.1016/j.jogn.2016.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the perceptions of Chilean women about why women choose to have or not have Pap test screening. DESIGN Qualitative research using content analysis according to Krippendorf. SETTING Four urban health clinics in Santiago, Chile. PARTICIPANTS Fifty-seven Chilean women. METHODS Audiotaped focus groups. RESULTS Six themes emerged: Reasons that make it difficult for women to schedule appointments, Characteristics of health professionals that make it difficult to have a Pap test, Characteristics of the test that are barriers to having a Pap test, The relationship of the test with cancer, Family context, and Each woman's personal characteristics. CONCLUSION Primary health care providers play an important role in promoting adherence to cervical cancer screening. Nurses should proactively address women's perceptions and knowledge about screening and openly and uniformly discuss the importance and benefits of Pap test screening.
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12
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Effectiveness of three interventions in improving adherence to cervical cancer screening. Eur J Cancer Prev 2015; 25:423-9. [PMID: 26301923 DOI: 10.1097/cej.0000000000000201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In countries where cervical cancer screening programmes are conducted on an opportunistic basis, an active search for women at risk should be made to increase coverage. The objective of our study was to assess the effectiveness of three primary care interventions consisting of providing written, telephone and face-to-face information to increase screening participation among women over the age of 25 years. A randomized experimental study with only one post-test control group was conducted on women aged 25-70 years. A total of 1676 women were randomly distributed into four groups and the following interventions were implemented: written briefing; telephone briefing; an invitation to attend a group meeting and no briefing (control group). The women were evaluated 2 years after the intervention. The outcome variable was participation or nonparticipation in cervical cancer screening. It proved possible to interview a total of 1122 women. Among the groups, homogeneity was tested in terms of sociodemographic characteristics and health-related variables. Women who had undergone cytological testing in the 2 years preceding evaluation had a lower mean age (P<0.001) than women who had not done so (45.5±11.0 vs. 48.8±13.0 years). The proportion of women who had participated in screening was as follows: 35.3% in the written information group [95% confidence interval (CI) 29.8-40.9]; 38.4% in the telephone information group (95% CI 32.5-44.2); 29.3% in the face-to-face information group (95% CI 22.8-35.7) and 26.1% in the control group (95% CI 21.2-30.9), with this difference proving statistically significant (P=0.005). Logistic regression showed that only the interventions based on written or telephone briefing were effective vis-à-vis the control group. In conclusion, both written and telephone information can serve to improve women's participation in opportunistic cervical cancer screening. Current preventive strategies could be optimized by means of simple interventions within the scope of health professionals.
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MacLaughlin KL, Swanson KM, Naessens JM, Angstman KB, Chaudhry R. Cervical cancer screening: a prospective cohort study of the effects of historical patient compliance and a population-based informatics prompted reminder on screening rates. J Eval Clin Pract 2014; 20:136-43. [PMID: 24237657 DOI: 10.1111/jep.12098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2013] [Indexed: 11/24/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to assess the impact of historical screening compliance with the effectiveness of patient reminder letters on cervical cancer screening rates. METHOD Using population-based informatics systems, women with no cervical cancer screening in the prior 3 years were identified in two primary care clinics, Mayo Family Clinic Northeast (NE; n = 1613) and Northwest (NW; n = 1088). Patients were divided into two compliance groups: overdue/unknown screening status at study start or previously compliant. The NE Clinic sent reminder letters over a 6 months window to patients eligible for screening at the study start or during the study that were also identified as employees/dependents (E/D). There were 795 intervention (NE Clinic E/D patients) and 1906 control subjects. Using an intent-to-treat analysis, differences in screening rates were assessed. RESULTS A higher unadjusted screening rate was observed for the E/D group than the non-E/D group at both sites (32.7 versus 18.2% at NW, P < 0.001; 39.0 versus 14.7% at NE, P < 0.001). For the historically compliant group, unadjusted screening rates were higher for those who received letters (E/D subjects at NE) versus those who did not (E/D subjects at NW; 56.1 versus 44.5%, P = 0.01). No difference was observed between E/D subjects at NE (received letters) and NW (no letters) for the overdue/unknown group (27.4 versus 25.9%, P = 0.62). There was no difference in screening rates for non-E/D subjects at NE versus at NW (none of whom received letters) for both the compliant (24.2 versus 30.6%, P = 0.18) and the overdue/unknown groups (11.9 versus 13.0%, P = 0.59). Multivariate logistic regression models showed a significant overall effect of E/D status (P = 0.006), compliance group (P < 0.001), and the interaction between clinic site and E/D status (P = 0.04). CONCLUSION Among insured women, reminder letters appear to improve cervical cancer screening rates for those with a history of screening compliance. Reminder letters appear insufficient to motivate women if screening is overdue. Further investigation of the cohort of women overdue for screening is needed to develop interventions to successfully target this group.
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Roland KB, Benard VB, Soman A, Breen N, Kepka D, Saraiya M. Cervical cancer screening among young adult women in the United States. Cancer Epidemiol Biomarkers Prev 2013; 22:580-8. [PMID: 23355601 DOI: 10.1158/1055-9965.epi-12-1266] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cervical cancer screening guidelines have evolved significantly in the last decade for young adult women, with current recommendations promoting later initiation and longer intervals. METHODS Using self-reported cross-sectional National Health Interview Survey (NHIS) 2000-2010 data, trends in Papanicolaou (Pap) testing among women ages 18-29 years were examined. NHIS 2010 data were used to investigate age at first Pap test (N = 2,198), time since most recent Pap test (n = 1,622), and predictors of Pap testing within the last 12 months (n = 1,622). RESULTS The percentage of 18-year-olds who reported ever having a Pap test significantly decreased from 49.9% in 2000 to 37.9% in 2010. Mean age at first Pap test in 2010 was significantly younger for non-Hispanic black women (16.9 years), women < high school education (16.9 years), women who received the HPV vaccine (17.1 years), and women who have ever given birth (17.3 years). The majority reported their last Pap test within the previous 12 months (73.1%). Usual source of healthcare (OR, 2.31) and current birth control use (OR, 1.64) significantly increased chances of having a Pap test within the previous 12 months. CONCLUSIONS From 2000 to 2010, there was a gradual decline in Pap test initiation among 18-year-olds; however, in 2010, many women reported ≤12 months since last screening. Evidence-based guidelines should be promoted, as screening young adult women for cervical cancer more frequently than recommended can cause considerable harms. IMPACT A baseline of cervical cancer screening among young adult women in the United States to assess adherence to evidence-based screening guidelines.
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Affiliation(s)
- Katherine B Roland
- Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS K-55, Atlanta, GA 30341, USA.
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