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Bergstein A, Huang Y, Hershman DL, Xu X, Wright J. Impact of medicaid expansion on cervical cancer screening: A state-specific difference in difference analysis. Gynecol Oncol 2024; 189:49-55. [PMID: 39013240 DOI: 10.1016/j.ygyno.2024.06.028] [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: 04/17/2024] [Revised: 06/24/2024] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE In 2014 the Affordable Care Act expanded Medicaid coverage in states that opted to participate. Limited data are available describing the effect of Medicaid expansion on cancer screening. The objective of our study was to evaluate trends in cervical cancer screening associated with Medicaid expansion. METHODS Using data from the Behavioral Risk Factor Surveillance System, we identified female respondents ages 30-64 years with a household income below $35,000. The outcome measure was guideline-adherent cervical cancer screening. The years 2010 and 2012 constituted the pre-expansion period while 2016 and 2018 were used to capture the post-expansion period. A difference-in-difference (DID) analysis was performed to assess changes in cervical cancer screening in Medicaid expansion states compared to non-expansion states, for the overall sample and for each expansion state individually. RESULTS The overall DID analysis showed a greater increase in cervical cancer screening by 1.1 percentage points (95% CI: 0.1 to 2.0%, P = 0.03) in expansion states compared to non-expansion states. The analysis comparing individual expansion states to non-expansion states showed that 6 expansion states had a significantly higher increase in screening relative to non-expansion states: Oregon (8.5%, P < 0.001), Kentucky (4.5%, P = 0.001), Washington (4.2%, P = 0.002), Colorado (4.3%, P = 0.008), Nevada (4.7%, P = 0.048), and Ohio (2.8%, P = 0.03). Of these states, 5 ranked among the states with the lowest baseline screening rates. CONCLUSIONS Medicaid expansion states experienced a greater increase in cervical cancer screening relative to non-expansion states. Expansion states with lower baseline screening rates experienced greater increases in screening after expanding Medicaid.
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Affiliation(s)
- Adrianna Bergstein
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Dawn L Hershman
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA
| | - Xiao Xu
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Jason Wright
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA.
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Kirkpatrick CE, Lawrie LL. Can Videos on TikTok Improve Pap Smear Attitudes and Intentions? Effects of Source and Autonomy Support in Short-Form Health Videos. HEALTH COMMUNICATION 2024; 39:2066-2078. [PMID: 37691164 DOI: 10.1080/10410236.2023.2254962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
This study was designed to test the effects of two message features (source and level of autonomy support) that are commonly found in short-form social media (e.g. TikTok) videos about Pap tests. The source is defined as who is communicating the message, and autonomy support refers to providing an individual with the independence, respect, and choice to make their own decision. In an online experiment, 636 females aged 21-29 viewed TikTok videos about Pap tests varying in source (doctor vs. peer) and level of autonomy support (either using controlling language to demand getting a Pap test or being supportive of one's choice of whether they receive a Pap test) and then responded to outcomes measures including perceived source credibility, perceived message effectiveness, attitude toward the message, attitude toward Pap tests, intention to engage with the videos, and intention to get a Pap test. Doctors were perceived as more credible than peers, and doctor videos were perceived to be more effective than peer videos. Autonomy support interacted with source, such that autonomy-supportive videos delivered by a doctor improved attitude toward the messaging and attitude toward Pap tests. Regardless of the source, autonomy-supportive videos increased intention to engage with the content on social media. As Pap test rates have recently declined among young women in the United States and viewing of Pap test-related videos has skyrocketed on the TikTok platform, short-form social media sites like TikTok may be an effective health communication tool for health professionals.
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Bengtson L, Lynch S. Trauma, PTSD, and Self-Efficacy: Predictors of Cervical Cancer Screening in Sexual Violence Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241265431. [PMID: 39045760 DOI: 10.1177/08862605241265431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Sexual violence is highly prevalent in the United States and is associated with a host of negative physical and mental health outcomes. Specifically, sexual violence is associated with increased rates of cervical cancer, one of the most common cancers found in women. Furthermore, sexual violence survivors report reduced participation in preventive healthcare behaviors (e.g., Pap tests) which may reduce individuals' risk of developing reproductive health conditions such as cancer. Sexual violence exposure is also associated with increased symptoms of posttraumatic stress disorder (PTSD) and reduced trauma-coping self-efficacy (TCSE), two factors that may impact trauma-exposed individuals' level of avoidance of cervical cancer screens. Current research on the connection between sexual violence and reproductive healthcare often fails to examine potential underlying mechanisms behind this association, nor does it account for confounding factors such as healthcare accessibility and need. Accordingly, the present study tested a proposed moderated mediation model to explore the association between sexual violence and cervical cancer screening participation, including analysis of the indirect effect of TCSE and potential moderation of this effect by PTSD symptoms. Participants were 554 participants who reported experiences of sexual violence on Amazon's Mechanical Turk. Severity of sexual violence was significantly associated with reduced likelihood of participation in recommended cervical cancer screening. TCSE did not mediate nor did PTSD moderate this association. Findings of this study suggest that individuals' reproductive healthcare behaviors are influenced by their experiences of sexual trauma, as well as by structural factors such as insurance and income. Limitations, directions for future research, and clinical implications of study findings are discussed.
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Makioka D, Inada M, Awano M, Saito E, Shinoda T, Abe S, Yoshimura T, Müller M, Sasagawa T, Ito E. Quantification of HPV16 E7 Oncoproteins in Urine Specimens from Women with Cervical Intraepithelial Neoplasia. Microorganisms 2024; 12:1205. [PMID: 38930587 PMCID: PMC11205804 DOI: 10.3390/microorganisms12061205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/03/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
We present the validity of using an ultrasensitive enzyme-linked immunosorbent assay (ELISA) for quantifying high-risk human papillomavirus (HPV) 16 E7 oncoproteins in urine specimens as a noninvasive method of analyzing the oncogenic activity of HPV. Some reports claim that the oncogenic activity of HPV is a more relevant clinical indicator than the presence of HPV DNA for estimating malignant potential. In the present study, urine containing HPV16 and related types were selected by uniplex E6/E7 polymerase chain reaction and classified according to the pathologic diagnosis of cervical intraepithelial neoplasia (CIN) in cervical biopsy specimens. Our ultrasensitive ELISA was able to detect attomole levels of HPV16 E7 oncoproteins, and it detected HPV16-positive SiHa cells at >500 cells/mL without detecting HPV18-positive cells. Our ELISA results showed E7 oncoproteins in 80% (4/5) of urine specimens from women with HPV16-positive CIN1, 71% (5/7) of urine specimens from CIN2 patients, and 38% (3/8) of urine specimens from CIN3 patients. Some urine specimens with undetectable E7 oncoproteins were thought to be negative for live HPV 16-positive cells or in an inactivated state of infection. These results provide the basis for assessing oncogenic activity by quantifying E7 oncoproteins in patient urine.
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Affiliation(s)
- Daiki Makioka
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Mikio Inada
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Masayuki Awano
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Ema Saito
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Takuya Shinoda
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Satoko Abe
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Teruki Yoshimura
- School of Pharmaceutical Sciences, Health Sciences University of Hokkaido, Tobetsu 061-0293, Hokkaido, Japan;
| | - Martin Müller
- Tumorvirus-Specific Vaccination Strategies, Deutsche Krebsforschungszentrum (DKFZ), 69120 Heidelberg, Germany;
| | - Toshiyuki Sasagawa
- Department of Obstetrics and Gynecology, Kanazawa Medical University, Uchinada 920-0293, Ishikawa, Japan
| | - Etsuro Ito
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Khoja L, Torres HG, Hak L, Aljebori M, Phung MT, Sakleh A, Stiffler M, Tariq M, Pearce CL. Cervical cancer screening and vaccination acceptability and attitudes among Arab American women in Southeastern Michigan: a qualitative study. Sci Rep 2024; 14:13624. [PMID: 38871762 PMCID: PMC11176183 DOI: 10.1038/s41598-024-64462-1] [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: 11/09/2023] [Accepted: 06/10/2024] [Indexed: 06/15/2024] Open
Abstract
Among Arab-American women in Michigan, rates of cervical cancer screening are lower than those in non-Hispanic White and Black women in the state. A deep understanding of the Arab community's perspective on cervical cancer screening is needed to address the disparity in rates across populations in Michigan. Arab and Chaldean women across Michigan were invited to participate in Zoom-based focus groups to understand the attitudes, acceptability, and barriers of cervical cancer screening among this population. Four focus groups with a total of 19 women aged 30 to 61 were conducted. The focus groups were conducted in English, Arabic, or both languages. The guided discussion was focused on knowledge of cervical cancer and Human papillomavirus (HPV) and its transmission, attitudes towards HPV vaccination, and attitudes towards cervical cancer screening. HPV self-sampling as an alternative to traditional provider-based screening was specifically discussed as this has been proposed as a way to increase screening in hard-to-reach populations. The conversations revealed insights related to barriers at the individual and community levels for screening and vaccination, attitudes towards preventive health care including screening, a need for accessible women's health literature, and health education. The women also discussed vaccine hesitancy related to HPV and COVID-19, suggesting a need for targeted community interventions.
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Affiliation(s)
- Lilah Khoja
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Heidi G Torres
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Layla Hak
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Manar Aljebori
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Minh Tung Phung
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Andrea Sakleh
- Center for Arab Narratives at the Arab American National Museum, ACCESS, 6450 Maple St., Dearborn, MI, 48126, USA
| | - Matthew Stiffler
- Center for Arab Narratives at the Arab American National Museum, ACCESS, 6450 Maple St., Dearborn, MI, 48126, USA
| | - Madiha Tariq
- ACCESS Community Health and Research Center, 6450 Maple St., Dearborn, MI, 48126, USA
| | - Celeste Leigh Pearce
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
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Tsige AW, Beyene DA. Cervical cancer: Challenges and prevention strategies: A narrative review. Health Sci Rep 2024; 7:e2149. [PMID: 38826620 PMCID: PMC11139676 DOI: 10.1002/hsr2.2149] [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: 02/03/2024] [Revised: 03/25/2024] [Accepted: 05/09/2024] [Indexed: 06/04/2024] Open
Abstract
Background and Aims Human papillomavirus (HPV) infections that continue to exist are the main cause of cervical cancer (CC), two-thirds of CC occurrences worldwide are caused by HPV 16 and HPV 18, and 99.7% of CC tumors are linked to oncogenic HPV infection. To identify challenges of CC and its prevention and treatment modalities. Methods This review examined the epidemiology, predisposing factors, genetic factors, clinical assessment methods, current treatment options, and prevention approaches for CC. We had perform a narrative data synthesis rather than a pooled analysis. A thorough literature search in pertinent databases related to CC was done with the inclusion of data that were published in the English language. Results Early detection of CC is of utmost importance to detect precancerous lesions at an early stage. Therefore, all responsible agencies concerned with health should make all women aware of the benefits of CC screening and educate the general public. HPV vaccination coverage is very low in resource-limited settings. Conclusion To achieve the goal of eliminating CC as a public health problem in 2030, the World Health Organization will pay special attention to increasing HPV vaccination coverage throughout the world. To further improve HPV vaccine acceptability among parents and their children, safety-related aspects of the HPV vaccine should be further investigated through post-marketing surveillance and multicentre randomized clinical trials.
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Affiliation(s)
- Abate Wondesen Tsige
- Department of Pharmacy, Asrat Woldeyes Health Science CampusDebre Berhan UniversityDebre BerhanEthiopia
| | - Dessale Abate Beyene
- Department of Pharmacy, Asrat Woldeyes Health Science CampusDebre Berhan UniversityDebre BerhanEthiopia
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Mooses K, Šavrova A, Pajusalu M, Oja M, Tamm S, Haug M, Padrik L, Laanpere M, Uusküla A, Kolde R. Using electronic health records to evaluate the adherence to cervical cancer prevention guidelines: A cross-sectional study. Prev Med 2024; 183:107982. [PMID: 38701952 DOI: 10.1016/j.ypmed.2024.107982] [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] [Received: 02/02/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The fight against cervical cancer requires effective screening together with optimal and on-time treatment along the care continuum. We examined the impact of cervical cancer testing and treatment guidelines on testing practices, and follow-up adherence to guidelines. METHODS Data from Estonian electronic health records and healthcare provision claims for 50,702 women was used. The annual rates of PAP tests, HPV tests and colposcopies during two guideline periods (2nd version 2012-2014 vs 3rd version 2016-2019) were compared. To assess the adherence to guidelines, the subjects were classified as adherent, over- or undertested based on the timing of the appropriate follow-up test. RESULTS The number of PAP tests decreased and HPV tests increased during the 3rd guideline period (p < 0.01). During the 3rd guideline period, among 21-29-year-old women, the adherence to guidelines ranged from 38.7% (44.4…50.1) for ASC-US to 73.4% (62.6…84.3) for HSIL and among 30-59-year-old from 49.0% (45.9…52.2) for ASC-US to 65.7% (58.8…72.7) for ASCH. The highest rate of undertested women was for ASC-US (21-29y: 25.7%; 30-59y: 21.9%). The rates of over-tested women remained below 12% for all cervical pathologies observed. There were 55.2% (95% CI 49.7…60.8) of 21-24-year-olds and 57.1% (95% CI 53.6…60.6) of 25-29-year-old women who received HPV test not adherent to guidelines. CONCLUSIONS Our findings highlighted some shortcomings in guideline adherence, especially among women under 30. The insights gained from this study help to improve the quality of care and, thus, reduce cervical cancer incidence and mortality.
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Affiliation(s)
- Kerli Mooses
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
| | | | - Maarja Pajusalu
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
| | - Marek Oja
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
| | - Sirli Tamm
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
| | - Markus Haug
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
| | - Lee Padrik
- Tartu University Hospital Women's Clinic, L. Puusepa 8, 50406 Tartu, Estonia.
| | - Made Laanpere
- Tartu University Hospital Women's Clinic, L. Puusepa 8, 50406 Tartu, Estonia; Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia.
| | - Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia.
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
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Mu TS, Duran-Stanton A, Stone EA, Zarzabal LA, Loewendorf A. Rates of Preeclampsia and Post-preeclamptic Cardiovascular Disease Among US Military Servicewomen: A Retrospective Case-cohort Study. Mil Med 2024; 189:1210-1215. [PMID: 37540580 PMCID: PMC11110618 DOI: 10.1093/milmed/usad300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/31/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Preeclampsia (PE), a hypertensive-inflammatory disorder of pregnancy, poses acute risks of seizures, stroke, and heart attack during pregnancy and up to 6 weeks post-delivery. Recent data suggest that residual increased risks for cardiovascular disease (CVD) linger for much longer, possibly decades, after PE pregnancies. In civilian studies, PE and the major vascular events resulting from it disproportionately affect women from minority groups, especially African American women. The Military Health System (MHS) provides equal access to care for all active-duty servicewomen (ADSW), thus theoretically mitigating disparities. Racial/ethnic breakdown for PE and post PE CVD has not been studied in the MHS. MATERIALS AND METHODS We identified healthy pregnancies in the MHS electronic health records of ADSW in the years 2009/2010 and those with a PE diagnosis. Patients with preexisting conditions of PE or CVD based on a look-back period of two calendar years were excluded. Cases were matched to controls based on age at pregnancy within 5 years and race/ethnicity. Cohort was assessed for diagnosed CVDs, race, age, and service during 2011-2017. Time to first CVD event was assessed with Cox proportional hazards model, results reported as relative risks (95% CI). All variables were summarized using mean (SD) for normally distributed continuous variables; non-normal continuous variables were characterized by median [IQR] and categorical variables were summarized by counts and frequencies. All statistical testings were two-sided with a significance level of 5% and were completed using SAS-EG version 9.2 or R version 3.5.2. RESULTS From an analysis of 106,808 inpatient ADSW records, PE incidence by race is 11.8% for White, 12% for African American, 11.4% for Asian/Pacific Islander, 11.2% for Native American, 9.5% for Other, and 7.6% for unknown (not documented) race. Thus, in the US Military, African American women have comparable (0.2% higher) PE rate than White women in contrast with civilian studies that often report much higher incidence in the African American population. Using Asians as referent group, PE increases the risk of CVD. White women have a hazard ratio (HR) of 1.47 95%CI (1.15-1.88), African Americans a HR of 1.51 95% CI (1.18-1.93), and Other a HR of 1.39 95% CI (1.01-1.91). CONCLUSION In this study, we report overall higher incidence of PE in military women than what is published for civilian women in all races and across all services. Importantly, we do not find significantly higher numbers of PE and post-PE CVD for African American, compared to White women in the military. Our study is not designed to address differences between military and civilian PE epidemiology, but these results deserve further exploration. This study shines light on a health risk unique to women, which we found to be more prevalent in the US Military than published civilian population. Further study to determine the details of long-term morbidity, disability, and death attributable to PE (CVD, stroke, and kidney diseases) are needed to design optimal medical management protocols, ensure readiness for duty, and protect our Women Warfighters.
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Affiliation(s)
- Thornton S Mu
- Brooke Army Medical Center, JBSA Ft. Sam Houston, TX 78219, USA
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Dorismond VG, Saraiya M, Gopalani SV, Soman A, Kenney K, Miller J, Sawaya GF. Variation in cervical cancer screening test utilization and results in a United States-based program. Gynecol Oncol 2024; 184:96-102. [PMID: 38301312 DOI: 10.1016/j.ygyno.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Little is known about cervical cancer screening strategy utilization (cytology alone, cytology plus high-risk human papillomavirus [HPV] testing [cotesting], primary HPV testing) and test results in the United States. METHODS Data from the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program were analyzed for 199,578 persons aged 21-65 years screened from 2019 to 2020. Screening test utilization and results were stratified by demographic characteristics and geographic region. Age-standardized pooled HPV test positivity and genotyping test positivity were estimated within cytology result categories. RESULTS Primary HPV testing was performed in 592 persons (0.3%). Among the remaining 176,290 persons aged 30-65 years, cotesting was utilized in 72.1% (95% confidence interval [CI] 71.9-72.3%), and cytology alone was utilized in 27.9% (95% CI 27.7-28.1%). Utilization of cytology alone varied by geographic region, ranging from 18.3% (95% CI 17.4-19.1%) to 49.0% (95% CI 48.4-49.6%). HPV genotyping test utilization among those with positive pooled HPV test results was 33.9%. In persons aged ≥30 years, variations in age-adjusted test results by region were observed for pooled HPV-positive test results and for HPV genotyping-positive test results. CONCLUSIONS Cervical cancer screening strategy utilization and test results vary substantially by geographic region within a national screening program. Variation in utilization may be due to regional differences in screening test availability or the preferences of healthcare systems, screened persons and/or clinicians. Test result variations may reflect differing risk factors for HPV infections by geographic region.
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Affiliation(s)
- Vanessa G Dorismond
- Department of Obstetrics, Gynecology, and Reproductive Sciences; University of California San Francisco, San Francisco, CA, USA.
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sameer V Gopalani
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Kristy Kenney
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jacqueline Miller
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences; University of California San Francisco, San Francisco, CA, USA; Center for Healthcare Value, University of California San Francisco, San Francisco, CA, USA
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Ehman KM, Jenkins GD, Grimm JA, Cammack TL, Samuelson BJ, Stoll RJ, Maxson JA, MacLaughlin KL. Primary Human Papillomavirus Test Uptake and Cervical Cancer Screening Trends in the Midwest, United States. J Prim Care Community Health 2024; 15:21501319241251934. [PMID: 38726652 PMCID: PMC11085000 DOI: 10.1177/21501319241251934] [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: 02/05/2024] [Revised: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION/OBJECTIVES Despite U.S. Preventive Services Task Force and American Cancer Society endorsement of primary HPV screening, limited published data shows low uptake. PRIMARY AIM Assess cervical cancer screening rates over time, particularly primary HPV test uptake, among patients in a midwestern practice. SECONDARY AIM Evaluate associations between sociodemographics and screening adherence. METHODS Cross-sectional study. Qualifying subjects and type of screening test used were identified by applying ICD-9, ICD-10, lab test, and CPT codes to the Unified Data Platform. Sociodemographics were found through the electronic health record. RESULTS Primary HPV uptake represented <1% of annual screening from 1/2017 to 1/2022. On 1/1/2022, only 55% of 21 to 29 year old and 63% of 30 to 65 year old were up to date with screening among the studied population. For 21 to 29 year old, compared with White women, Black women were 28% less likely to be screened [RR = 0.72 (0.66-0.79)]. Compared with never-smokers, current smokers were 9% less likely to be screened [RR = 0.91 (0.87-0.96)], past smokers were 14% more likely [RR = 1.14 (1.09-1.2)]. Among 30 to 65 year old, compared with White women, Black women were 14% less likely to be screened [RR = 0.86 (0.81-0.9)]. Compared with never-smokers, current smokers were 21% less likely to be screened [RR = 0.79 (0.77-0.81)], past smokers were 6% less likely [RR = 0.94 (0.92-0.95)]. Jointly considering race, ethnicity, smoking status, Charlson score, and rurality, findings were similar for 21 to 29 year old; Black women were screened less than White women [RR = 0.73 (0.67-0.79)]; current smokers [RR = 0.9 (0.85-0.94)] and past smokers [RR = 1.12 (1.06-1.17)] were screened less than never smokers. For 30 to 65 year old, Black women were screened less than White women [RR = 0.83 (0.79-0.88)]; current smokers [RR = 0.8 (0.78-0.81)] and past smokers [RR = 0.95 (0.93-0.96)] were screened less than never smokers. CONCLUSIONS Screening rates remained below the Healthy People 2030 goal of 79.2% over time, particularly for younger Black women and current smokers, with minimal use of primary HPV screening.
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Affiliation(s)
- Katie M. Ehman
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Gregory D. Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jessica A. Grimm
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Julie A. Maxson
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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Bukowski A, Smith JS, Wheeler SB, Sanusi B, McGuire FH, Zeno E, Des Marais AC, Barclay L, Hudgens MG, Jackson S, Brewer NT. Cervical Cancer Screening Knowledge, Perceptions, and Behaviors in a Multiracial Cohort of Low-Income, Underscreened Women in North Carolina. J Womens Health (Larchmt) 2023; 32:970-981. [PMID: 37327372 PMCID: PMC10510685 DOI: 10.1089/jwh.2022.0412] [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] [Indexed: 06/18/2023] Open
Abstract
Background: Underscreened, low-income, and uninsured or publicly insured women in the United States bear a greater burden of cervical cancer morbidity and mortality and may face unique barriers that preclude screening adherence. Methods: Participants were 710 My Body My Test-3 clinical trial participants who were publicly insured or uninsured with incomes ≤250% of the U.S. Federal Poverty Level, aged 25-64 years, and not up to date on cervical cancer screening as per national guidelines. Using Health Belief Model constructs, we assessed screening-related knowledge, perceptions, and behaviors-overall and stratified by race and ethnicity-and estimated associations with past-year attempted screening using multivariable regression models. Results: Overall, knowledge was low about the human papillomavirus, purpose of a Pap test, and recommended screening interval. Perceived severity of cervical cancer was high (3.63 on a 4-point scale). Black and Latina/Hispanic women were more likely to perceive screening as lowering their risk of cervical cancer than White women. Black women reported lower perceived risk of cervical cancer compared with White women (p = 0.03), but Black women were more likely to have sought screening in the past year (p = 0.01). Having at least three doctor visits in the past year was associated with a screening attempt. Greater perceived risk of cervical cancer, more positive perceptions of screening, and feeling more nervousness about screening were also associated with a screening attempt (all p < 0.05). Conclusions: Addressing knowledge gaps and misconceptions about cervical cancer screening and leveraging positive perceptions of screening may improve screening uptake and adherence among diverse underscreened U.S. women. Clinical Trial Registration Number: NCT02651883.
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Affiliation(s)
- Alexandra Bukowski
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer S. Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Busola Sanusi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - F. Hunter McGuire
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erica Zeno
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrea C. Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lynn Barclay
- American Sexual Health Association, Research Triangle Park, North Carolina, USA
| | - Michael G. Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sarah Jackson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Wanberg LJ, Kim A, Vogel RI, Sadak KT, Teoh D. Usability and Satisfaction Testing of Game-Based Learning Avatar-Navigated Mobile (GLAm), an App for Cervical Cancer Screening: Mixed Methods Study. JMIR Form Res 2023; 7:e45541. [PMID: 37552527 PMCID: PMC10445170 DOI: 10.2196/45541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/09/2023] [Accepted: 07/04/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Barriers to cervical cancer screening in young adults include a lack of knowledge and negative perceptions of testing. Evidence shows that mobile technology reduces these barriers; thus, we developed a web app, Game-based Learning Avatar-navigated mobile (GLAm), to educate and motivate cervical cancer screening using the Fogg Behavioral Model as a theoretic guide. Users create avatars to navigate the app, answer short quizzes with education about cervical cancer and screening, watch videos of the screening process, and earn digital trophies. OBJECTIVE We tested ease of use, usefulness, and satisfaction with the GLAm app among young adults. METHODS This mixed methods study comprised a qualitative think-aloud play interview session and a quantitative survey study. Participants were cervical cancer screening-eligible US residents aged 21 to 29 years recruited through social media. Qualitative study participants explored the app in a think-aloud play session conducted through videoconference. Data were analyzed using directed content analysis to identify themes of ease of use, usefulness, and content satisfaction. Qualitative study participants and additional participants then used the app independently for 1 week and completed a web-based survey (the quantitative study). Ease of use, usefulness, and satisfaction were assessed using the validated Technology Acceptance Model and Computer System Usability Questionnaire adapted to use of an app. Mean (SD) scores (range 1-7) are presented. RESULTS A total of 23 individuals participated in one or both study components. The mean age was 25.6 years. A majority were cisgender women (21/23, 91%) and White (18/23, 78%), and 83% (19/23) had at least some secondary education. Nine participants completed the think-aloud play session. Direct content analysis showed desire for content that is concise, eases anxiety around screenings, and uses game features (avatars and rewards). Twenty-three individuals completed the quantitative survey study. Mean scores showed the app was perceived to be easy to use (mean score 6.17, SD 0.27) and moderately useful to increase cervical cancer screening knowledge and uptake (mean score 4.94, SD 0.27). Participants were highly satisfied with the app (mean score 6.21, SD 1.20). CONCLUSIONS Survey results showed participants were satisfied with the app format and found it easy to use. The app was perceived to be moderately useful to inform and motivate cervical cancer screening; notably, the screening reminder function was not tested in this study. Qualitative study results demonstrated the app's ability to ease anxiety about screening through demonstration of the screening process, and brevity of app components was favored. Interpretation of results is limited by the predominantly cisgender, White, and educated study population; additional testing in populations which historically have lower cervical cancer screening uptake is needed. A modified version of the app is undergoing efficacy testing in a randomized clinical trial.
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Affiliation(s)
- Lindsey J Wanberg
- Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Angela Kim
- Laboratory of Cell and Developmental Signaling, National Cancer Institute, National Institutes of Health, Frederick, MD, United States
| | - Rachel I Vogel
- Division of Gynecologic Oncology, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Karim Thomas Sadak
- Division of Hematology Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Deanna Teoh
- Division of Gynecologic Oncology, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
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Spees LP, Biddell CB, Smith JS, Marais ACD, Hudgens MG, Sanusi B, Jackson S, Brewer NT, Wheeler SB. Cost-effectiveness of Human Papillomavirus Self-collection Intervention on Cervical Cancer Screening Uptake among Underscreened U.S. Persons with a Cervix. Cancer Epidemiol Biomarkers Prev 2023; 32:1097-1106. [PMID: 37204419 PMCID: PMC10524653 DOI: 10.1158/1055-9965.epi-22-1267] [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: 12/02/2022] [Revised: 02/05/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND We evaluate the cost-effectiveness of human papillomavirus (HPV) self-collection (followed by scheduling assistance for those who were HPV+ or inconclusive) compared with scheduling assistance only and usual care among underscreened persons with a cervix (PWAC). METHODS A decision tree analysis was used to estimate the incremental cost-effectiveness ratios (ICER), or the cost per additional PWAC screened, from the Medicaid/state and clinic perspectives. A hypothetical cohort represented 90,807 low-income, underscreened individuals. Costs and health outcomes were derived from the MyBodyMyTest-3 randomized trial except the usual care health outcomes were derived from literature. We performed probabilistic sensitivity analyses (PSA) to evaluate model uncertainty. RESULTS Screening uptake was highest in the self-collection alternative (n = 65,721), followed by the scheduling assistance alternative (n = 34,003) and usual care (n = 18,161). The self-collection alternative costs less and was more effective than the scheduling assistance alternative from the Medicaid/state perspective. Comparing the self-collection alternative with usual care, the ICERs were $284 per additional PWAC screened from the Medicaid/state perspective and $298 per additional PWAC screened from the clinic perspective. PSAs demonstrated that the self-collection alternative was cost-effective compared with usual care at a willingness-to-pay threshold of $300 per additional PWAC screened in 66% of simulations from the Medicaid/state perspective and 58% of simulations from the clinic perspective. CONCLUSIONS Compared with usual care and scheduling assistance, mailing HPV self-collection kits to underscreened individuals appears to be cost-effective in increasing screening uptake. IMPACT This is the first analysis to demonstrate the cost-effectiveness of mailed self-collection in the United States.
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Affiliation(s)
- Lisa P. Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Caitlin B. Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer S. Smith
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Andrea C. Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Michael G. Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Busola Sanusi
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sarah Jackson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Noel T. Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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Xiong S, Ghebre R, Kulasingam S, Mason SM, Pratt RJ, Lazovich D. Exploring factors associated with preferences for human papillomavirus (HPV) self-sampling among racially- and ethnically-diverse women in Minnesota: A cross-sectional study. Prev Med Rep 2023; 34:102243. [PMID: 37234567 PMCID: PMC10206196 DOI: 10.1016/j.pmedr.2023.102243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Pap tests are still underutilized by minority women due to limited awareness of cervical cancer screening (CCS), inadequate health care access, and cultural or religious beliefs. Human papillomavirus (HPV) self-sampling, a new CCS tool, has demonstrated potential to overcome some of these barriers. In 2021, women aged 30-65 years old were recruited across Minnesota to complete an online survey. The survey assessed five outcome measures related to HPV self-sampling: (1) awareness of test; (2) self-efficacy to conduct test; (3) location preference of test (clinic vs. home); 4) collector preference (self vs. clinician); and (5) preference of CCS strategy (HPV self-sampling vs. Pap test). Modified Poisson regressions tested associations between sociodemographic variables and outcomes. A total of 420 women completed the survey, of which 32.4% identified as Non-Hispanic white, 22.2% as Hispanic, 12.6% as Black/African-American, 28.3% as Asian, 1.9% as American Indian/Alaskan Native, and 1.4% as more than two races. Few women had heard of HPV self-sampling (6.5%), but a majority reported high self-efficacy to perform self-sampling (75.3%). Women also reported higher preferences for completing an HPV test in the clinic (52.2%) and for performing a self-collected HPV test themselves (58.7%), yet would choose a traditional Pap test over HPV self-sampling (56.0%). The low level of HPV self-sampling awareness, across all racial/ethnic groups, suggests a strong opportunity to promote widespread educational efforts around this new tool. Future HPV self-sampling research efforts should examine educational interventions targeted at healthcare providers to educate and encourage women on the importance of self-collection options.
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Affiliation(s)
- Serena Xiong
- Department of Surgery, Washington University in St. Louis School of Medicine, 600 S Taylor Avenue, St. Louis, MO 63110, United States
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology and Women’s Health, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States
- Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455, United States
| | - Shalini Kulasingam
- Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455, United States
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd Suite 300, Minneapolis, MN 55454, United States
| | - Susan M. Mason
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd Suite 300, Minneapolis, MN 55454, United States
| | - Rebekah J. Pratt
- Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455, United States
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414, United States
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455, United States
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd Suite 300, Minneapolis, MN 55454, United States
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Fan C, Ma Q, Wu X, Dai X, Peng Q, Cai H. Detection of DNA Methylation in Gene Loci ASTN1, DLX1, ITGA4, RXFP3, SOX17, and ZNF671 for Diagnosis of Cervical Cancer. Cancer Manag Res 2023; 15:635-644. [PMID: 37457377 PMCID: PMC10349600 DOI: 10.2147/cmar.s417877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To evaluate the diagnostic value of DNA methylation detection of multiple gene loci in cervical cancer. Methods A total of 61 cases requiring cervical biopsy were selected from the outpatient clinic of Maternal and Child Health Hospital of Hubei Province between January 2018 and December 2019. The patients were divided into four groups based on histopathologic diagnosis: cervical cancer (CC) group, high-grade squamous intraepithelial lesion (HSIL) group, low-grade squamous intraepithelial lesion (LSIL) group, and control group. HPV examination, liquid-based cytology examination, and DNA methylation detection at multiple gene sites were performed. The positive rate of DNA methylation, sensitivity, specificity, area under the curve (AUC), and other efficacy indexes were calculated to evaluate the diagnostic value of DNA methylation detection at multiple gene loci in cervical cancer. Results The positive rates of DNA methylation in CC, HSIL, LSIL, and control groups were 100%, 88%, 83% and 17%, respectively. The ZNF671 gene had the highest positive rate among the cervical lesion group, with rates of 57%, 76%, and 100% in LSIL, HSIL, and CC groups respectively. The combination of DNA methylation detection at multiple gene loci showed the highest diagnostic efficacy for HSIL and cervical cancer, with AUC value of 0.850 (95% CI:0.746-0.954), a Youden index of 0.654, and a sensitivity and specificity of 85% and 85.4%, respectively. The diagnostic efficacy of the combined detection was significantly higher than that of HPV examination and liquid-based cytology examination (P < 0.05). Conclusion DNA methylation detection at multiple gene loci is highly effective and diagnostic tool for cervical cancer, and has potential application value in clinical practice.
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Affiliation(s)
- Chunli Fan
- Department of Scientific Research and Teaching Management Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, People’s Republic of China
- Department of Cervical Cancer Prevention Center, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, People’s Republic of China
| | - Quanfu Ma
- Department of Scientific Research and Teaching Management Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, People’s Republic of China
- Department of Cervical Cancer Prevention Center, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, People’s Republic of China
| | - Xufeng Wu
- Department of Cervical Cancer Prevention Center, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, People’s Republic of China
| | - Xuan Dai
- Department of Cervical Cancer Prevention Center, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, People’s Republic of China
| | - Qiuzi Peng
- Department of Cervical Cancer Prevention Center, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, People’s Republic of China
| | - Hongning Cai
- Department of Scientific Research and Teaching Management Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, People’s Republic of China
- Department of Cervical Cancer Prevention Center, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, People’s Republic of China
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Patel SS, Singh N, Jamwal A, Sahu C, Garg A, Rao N, Tejan N, Khan R. Comparison of Human Papillomavirus Genotype Detection in Paired Urine and Self-Collected Cervical Swabs: A Pilot Study. Asian Pac J Cancer Prev 2023; 24:2427-2430. [PMID: 37505776 PMCID: PMC10676509 DOI: 10.31557/apjcp.2023.24.7.2427] [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: 03/13/2023] [Accepted: 07/02/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVES With the objective of establishing a simple, cost-effective, and effective screening tool for the screening of Human Papilloma Virus infection, the study was undertaken. MATERIAL METHODS This pilot study was conducted on 20 urine samples of women whose cervical swabs were tested positive while screening for Human papilloma virus in asymptomatic women. RESULTS HPV genotypes were detected in 94% (16/17) patients in urine samples by real-time PCR while a 100% detection rate (15/15) was observed in the cervical swab samples. The results of the urine and cervical swab samples, tested by the TRUPCR ®HPV high-risk genotyping kit, are shown in Table 2. HPV genotype 68 was found in 82.3% urinary samples and 100% of self-collected vaginal swab samples. Out of 16 positive urine samples, 2 were positive for HPV genotype 16 and 5 were positive for HPV genotype 18, and in cervical swab testing out of 15 positive samples, 3 were positive for HPV genotype 16, and 5 were positive for HPV genotype 18. Diagnostic accuracy of urine was found to be 98.8% (95% CI 79.43% - 100.00%). CONCLUSION This pilot study aims to assess the accuracy of urine samples in the screening of HPV infection among asymptomatic women and establish the distribution of prevalent HPV genotypes. This may further contribute to standardizing the urine and cervical swab testing methods for cervical cancer screening strategies.
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Affiliation(s)
| | - Nilanchali Singh
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India.
| | - Ashima Jamwal
- Department of Microbiology, SGPGIMS, Lucknow, India.
| | - Chinmoy Sahu
- Department of Microbiology, SGPGIMS, Lucknow, India.
| | - Atul Garg
- Department of Microbiology, SGPGIMS, Lucknow, India.
| | - Nisha Rao
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India.
| | - Nidhi Tejan
- Department of Microbiology, SGPGIMS, Lucknow, India.
| | - Rashid Khan
- Department of Microbiology, SGPGIMS, Lucknow, India.
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17
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Johnson G, Miquel-Chambers C, Blas Y, Lowery S, Guerra L, Gonzalez E. Women's Health Maintenance Efforts at a Student-Run Free Clinic in South Florida Exceeded National Trends During the COVID-19 Pandemic. J Community Health 2023; 48:501-507. [PMID: 36719533 PMCID: PMC9887570 DOI: 10.1007/s10900-023-01190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic posed a setback to health maintenance screenings worldwide. These delays have impacted minorities and those of low socioeconomic status in the same way that disparities in cancer screenings have historically trended. Here, we evaluated the performance of a student-run free clinic in maintaining women up-to-date with cancer screenings before, during, and after the pandemic in relation to national trends. We identified all women eligible for screening mammography and cervical cancer screenings between 2018 and 2022 at the clinic (N = 185). Adequate adherence to screening was defined according to the American Cancer Society (ACS) recommendations for breast mammography, and the United States Preventive Services Task Force (USPSTF) guidelines for cervical cancer screenings. For cervical cancer screening, 166 female patients seen between 2018 and 2022 were eligible, and up-to-date proportions were as follows: 81.3% in 2018; 90.9% in 2019; 83.3% in 2020; 93.3% in 2021; 93.8% in 2022. For breast surveillance, 143 women were eligible for screening mammography, and up-to-date proportions were as follows: 66.7% in 2018; 62.5% in 2019; 91.7% in 2020; 73.1% in 2021; 84.1% in 2022. These proportions were higher than or near national averages.In conclusion, adherence remained steady during the pandemic and was not subject to the declines seen nationally. Our clinic represents an effective model for promoting women's health maintenance and tempering the disparities seen among women of low socioeconomic status.
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Affiliation(s)
- Grace Johnson
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | | | - Yohancie Blas
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Sylea Lowery
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Lucy Guerra
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Eduardo Gonzalez
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
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Huguet N, Ezekiel-Herrera D, Gunn R, Pierce A, O'Malley J, Jones M, Marino M, Gold R. Uptake of a Cervical Cancer Clinical Decision Support Tool: A Mixed-Methods Study. Appl Clin Inform 2023; 14:594-599. [PMID: 37532232 PMCID: PMC10411153 DOI: 10.1055/s-0043-1769913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/26/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES Clinical decision support (CDS) tools that provide point-of-care reminders of patients' care needs may improve rates of guideline-concordant cervical cancer screening. However, uptake of such electronic health record (EHR)-based tools in primary care practices is often low. This study describes the frequency of factors associated with, and barriers and facilitators to adoption of a cervical cancer screening CDS tool (CC-tool) implemented in a network of community health centers. METHODS This mixed-methods sequential explanatory study reports on CC-tool use among 480 community-based clinics, located across 18 states. Adoption of the CC-tool was measured as any instance of tool use (i.e., entry of cervical cancer screening results or follow-up plan) and as monthly tool use rates from November 1, 2018 (tool release date) to December 31, 2020. Adjusted odds and rates of tool use were evaluated using logistic and negative-binomial regression. Feedback from nine clinic staff representing six clinics during user-centered design sessions and semi-structured interviews with eight clinic staff from two additional clinics were conducted to assess barriers and facilitators to tool adoption. RESULTS The CC-tool was used ≥1 time in 41% of study clinics during the analysis period. Clinics that ever used the tool and those with greater monthly tool use had, on average, more encounters, more patients from households at >138% federal poverty level, fewer pediatric encounters, higher up-to-date cervical cancer screening rates, and higher rates of abnormal cervical cancer screening results. Qualitative data indicated barriers to tool adoption, including lack of knowledge of the tool's existence, understanding of its functionalities, and training on its use. CONCLUSION Without effective systems for informing users about new EHR functions, new or updated EHR tools are unlikely to be widely adopted, reducing their potential to improve health care quality and outcomes.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - David Ezekiel-Herrera
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Rose Gunn
- OCHIN Inc., Portland, Oregon, United States
| | | | | | | | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Rachel Gold
- OCHIN Inc., Portland, Oregon, United States
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, United States
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19
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Cooley JJP, Maguire FB, Morris CR, Parikh-Patel A, Abrahão R, Chen HA, Keegan THM. Cervical Cancer Stage at Diagnosis and Survival among Women ≥65 Years in California. Cancer Epidemiol Biomarkers Prev 2023; 32:91-97. [PMID: 36620897 PMCID: PMC9833840 DOI: 10.1158/1055-9965.epi-22-0793] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/13/2022] [Accepted: 10/31/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Through adequate screening and follow-up, cervical cancer can be prevented or detected at early-stage (stage I), which is related to excellent survival. Current guidelines recommend discontinuing screening for women ≥65 years with history of normal Pap and/or HPV tests, potentially leaving this age group vulnerable. This study examined late-stage disease in a population-based cohort. METHODS Using California Cancer Registry data, we identified 12,442 patients ages ≥21 years with a first primary cervical cancer diagnosed during 2009-2018. Proportions of late-stage disease (stages II-IV) and early- and late-stage 5-year relative survival are presented by the age group. Among patients ages ≥65 years, multivariable logistic regression estimated associations of sociodemographic and clinical characteristics with late-stage cervical cancer. RESULTS Nearly one fifth of patients (n = 2,171, 17.4%) were ≥65 years. More women ages ≥65 years (71%) presented with late-stage disease than younger women (48% in patients ages <65). Late-stage 5-year relative survival was lower for women ≥65 years (23.2%-36.8%) compared with patients <65 (41.5%-51.5%). Characteristics associated with late-stage cervical cancer in women ≥65 years included older age [odds ratio (OR), 1.02; 95% confidence interval (CI), 1.01-1.04; each year], non-adenocarcinoma histologic subtypes, and comorbidities (OR, 1.59; 95% CI, 1.21-2.08). CONCLUSIONS There remains a significant burden of advanced cervical cancer in women ≥65. IMPACT Efforts should be made to better understand how the current screening paradigm is failing women of 65 years and older. Future work should focus on determining past screening history, lapses in follow-up care, and non-invasive testing approaches.
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Affiliation(s)
- Julianne J. P. Cooley
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Frances B. Maguire
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Cyllene R. Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Renata Abrahão
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Davis Comprehensive Cancer Center, Sacramento, CA,Center for Healthcare Policy and Research, University of California Davis Health, Sacramento, CA
| | - Hui A. Chen
- University of California Davis Comprehensive Cancer Center, Department of Gynecology Oncology
| | - Theresa H. M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Davis Comprehensive Cancer Center, Sacramento, CA
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Sokale IO, Montealegre JR, Oluyomi AO, Thrift AP. Trends and Racial/Ethnic Differences in Predictors of Cervical Cancer Screening among US Women Ages 30-64 Years. Cancer Epidemiol Biomarkers Prev 2023; 32:82-90. [PMID: 36306382 PMCID: PMC9839647 DOI: 10.1158/1055-9965.epi-22-0970] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cervical cancer screening (CCS) participation has decreased in the United States over the last several decades, contributing to cervical cancer's sustained incidence and mortality. This study examined recent trends and racial/ethnic differences in predictors of CCS uptake among US women. METHODS We analyzed combined data from the 2016 to 2020 Behavioral Risk Factor Surveillance System (BRFSS) and included 235,713 women ages 30 to 64 years without a hysterectomy. We used simple linear regression to assess trends over time and multivariable logistic regression models to evaluate racial/ethnic differences in predictors of up-to-date CCS. RESULTS We found little change in CCS over the 5-year interval and screening rates disparities among racial minority women. The overall population showed stable CCS completion rates from 2016 to 2018 (84.2% vs. 84.6%), and then a small dip from 2018 to 2020 (from 84.6% to 83.3%). Despite a slight decline in 2020, HPV-based testing increased significantly among all subgroups and overall, from 2016 to 2020 (from 43.4% to 52.7%). Multivariable regression models showed racial/ethnic differences in predictors of CCS. Across all racial/ethnic subgroups, older women were less likely to receive timely screening. Women who had routine check-ups had higher odds of being up to date. However, the link between CCS and socioeconomic status varied. CONCLUSIONS Age and racial/ethnic disparities persist in CCS, and predictors of screening vary. Notwithstanding, routine health examinations was positively associated with screening regardless of race/ethnicity. IMPACT Our analyses suggest that leveraging primary care to optimize CCS uptake may reduce gaps in screening.
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Affiliation(s)
- Itunu O. Sokale
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jane R. Montealegre
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Abiodun O. Oluyomi
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Aaron P. Thrift
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
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Ferras M, Dye J, Ayala GX, Schmied E. An Examination of Factors That Influence Receipt of Reproductive Health Screenings Among Female Veterans. Mil Med 2023; 188:42-48. [PMID: 35253065 DOI: 10.1093/milmed/usac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/23/2022] [Accepted: 02/02/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION As the number of women veterans grows, so does the need to ensure they receive timely health care, including preventive reproductive health screenings such as cervical cancer screenings and mammograms. However, little is known about the rates of reproductive health screenings among veterans and what factors may be related to screening. The objectives of this cross-sectional study were to (1) understand healthcare treatment-seeking experiences among women veterans, (2) determine the rate of adherence to screening guidelines for cervical and breast cancers, and (3) examine potential correlates of adherence to clinical reproductive health screening guidelines. MATERIALS AND METHODS Women veterans completed an electronically administered survey, which assessed personal characteristics, psychological health symptoms, military service history, health insurance status, healthcare-seeking experiences (e.g., barriers to and satisfaction with care), and receipt of cervical and breast cancer screenings. Multivariable logistic regression identified factors associated with adherence to clinical guidelines for cervical and breast cancer screening. RESULTS Of the 90 women (mean age = 38.78; SD = 12.19) who participated, 64 (71.10%) reported meeting all age-applicable screening guidelines. The most common barriers to obtaining women's healthcare were availability of convenient appointment times, finding time in your schedule to make and go to an appointment, and long wait times for appointments. Multivariable logistic regression revealed veterans without a regular women's health provider were less likely to adhere to guidelines than those with a regular provider (OR = 0.16; 95% CI, 0.04-0.57). DISCUSSION Many women veterans are unable to receive reproductive health screenings; continued efforts are needed to determine how to increase adherence in this unique population.
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Affiliation(s)
- Madisen Ferras
- School of Public Health, San Diego State University, San Diego, CA 92182, USA
| | - Judy Dye
- School of Nursing, San Diego State University, San Diego, CA 92182, USA
| | - Guadalupe X Ayala
- School of Public Health, San Diego State University, San Diego, CA 92182, USA.,Institute for Behavioral and Community Health, San Diego, California; 9245 Sky Park Court, Suite 221,San Diego, CA 92123-4311, USA
| | - Emily Schmied
- School of Public Health, San Diego State University, San Diego, CA 92182, USA.,Institute for Behavioral and Community Health, San Diego, California; 9245 Sky Park Court, Suite 221, San Diego, CA 92123-4311, USA
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Bonuck KJ, Angier H, McCrimmon S, Holderness H, Erroba J, Huguet N, DeVoe JE, Carney PA. A Scoping Literature Review on Evidence-Based Strategies to Increase Cervical Cancer Screening. J Prim Care Community Health 2023; 14:21501319231220994. [PMID: 38131106 DOI: 10.1177/21501319231220994] [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] [Indexed: 12/23/2023] Open
Abstract
Previous reviews of strategies to increase cervical cancer screening are more than 10 years old, the U.S. continues to fall short of the Healthy People 2030 cervical cancer screening goal, and guidelines were revised in 2018, therefore an updated review of the existing literature is needed. We conducted a scoping review using electronic databases PubMed, Scopus, and Ovid Medline that included publication dates between 2012 and 2021 to answer the question, "Which strategies implemented in U.S. primary care settings have been most successful in increasing rates of cervical cancer screening since the 2012 US Preventative Services Task Force cervical cancer screening guidelines were published?" We mapped findings to pre-specified implementation strategy categories. After initially identifying 399 articles, we excluded 350 due to duplicates or not meeting review criteria, leaving 49 articles for full review. We excluded 37 of these during full-text review and identified 2 additional articles from the manual search of reference lists for a total of 14 studies for abstraction. Eleven articles reported on strategies resulting in increased cervical cancer screening, and 3 did not. Clinic workflow re-design strategies showed the greatest promise in improving cervical cancer screening rates, education strategies for patients had mixed results, and quality management strategies were not effective. These findings suggest clinical workflow re-structures and patient education strategies can increase cervical cancer screening in primary care settings. Results are particularly important in settings that care for underserved populations, as these settings may need additional implementation strategies to decrease cervical cancer screening disparities.
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Affiliation(s)
| | | | | | | | - Jeremy Erroba
- Oregon Health & Science University, Portland, OR, USA
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Lei F, Lee E. Cancer Screening Rates Among Asian Americans: A Cross-Sectional Secondary Data Analysis Study. Cancer Control 2023; 30:10732748231202462. [PMID: 37728218 PMCID: PMC10515548 DOI: 10.1177/10732748231202462] [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: 03/13/2023] [Revised: 08/02/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE This study aims 1) to investigate recent cancer screening rates among Asian Americans and 2) to test the relationship between race/ethnicity and cancer screening rates. METHODS This is a cross-sectional secondary data analysis study using data from the 2019 National Health Interview Survey. The screening rates of prostate cancer, colorectal cancer, cervical cancer, and breast cancer among non-Hispanic (NH) Asian Americans, Hispanics, NH Whites, NH African Americans, and NH American Indian and Alaska Natives (AIAN) were analyzed in July 2022. The variables were recoded and analyzed using descriptive analysis and chi-square test. The SPSS version 27 software was used. RESULTS Descriptive analysis showed a general low screening rate of cancers among Asian Americans, which ranged from 40.5% to 67.5%. The chi-square test suggested significant associations between race/ethnicity and the screening rates of colorectal cancer (P = .002), cervical cancer (P < .01), and breast cancer (P = .021), but not the prostate cancer (P = .472). CONCLUSION Necessary intervention programs should be designed to increase the uptake rates of cancer screening among Asian Americans.
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Affiliation(s)
- Fang Lei
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Eunice Lee
- School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
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24
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Qin J, Holt HK, Richards TB, Saraiya M, Sawaya GF. Use Trends and Recent Expenditures for Cervical Cancer Screening-Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years. JAMA Intern Med 2023; 183:11-20. [PMID: 36409511 PMCID: PMC9679959 DOI: 10.1001/jamainternmed.2022.5261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022]
Abstract
Importance Since 1996, the US Preventive Services Task Force has recommended against cervical cancer screening in average-risk women 65 years or older with adequate prior screening. Little is known about the use of cervical cancer screening-associated services in this age group. Objective To examine annual use trends in cervical cancer screening-associated services, specifically cytology and human papillomavirus (HPV) tests, colposcopy, and cervical procedures (loop electrosurgical excision procedure, cone biopsy, and ablation) in Medicare fee-for-service beneficiaries during January 1, 1999, to December 31, 2019, and estimate expenditures for services performed in 2019. Design, Setting, and Participants This population-based, cross-sectional analysis included health service use data across 21 years for women aged 65 to 114 years with Medicare fee-for-service coverage (15-16 million women per year). Data analysis was conducted between July 2021 and April 2022. Main Outcomes and Measures Proportion of testing modalities (cytology alone, cytology plus HPV testing [cotesting], HPV testing alone); annual use rate per 100 000 women of cytology and HPV testing, colposcopy, and cervical procedures from 1999 to 2019; Medicare expenditure for these services in 2019. Results There were 15 323 635 women 65 years and older with Medicare fee-for-service coverage in 1999 and 15 298 656 in 2019. In 2019, the mean (SD) age of study population was 76.2 (8.1) years, 5.1% were Hispanic, 0.5% were non-Hispanic American Indian/Alaska Native, 3.0% were non-Hispanic Asian/Pacific Islander, 7.4% were non-Hispanic Black, and 82.0% were non-Hispanic White. From 1999 to 2019, the percentage of women who received at least 1 cytology or HPV test decreased from 18.9% (2.9 million women) in 1999 to 8.5% (1.3 million women) in 2019, a reduction of 55.3%; use rates of colposcopy and cervical procedures decreased 43.2% and 64.4%, respectively. Trend analyses showed a 4.6% average annual reduction in use of cytology or HPV testing during 1999 to 2019 (P < .001). Use rates of colposcopy and cervical procedures decreased before 2015 then plateaued during 2015 to 2019. The total Medicare expenditure for all services rendered in 2019 was about $83.5 million. About 3% of women older than 80 years received at least 1 service at a cost of $7.4 million in 2019. Conclusions and Relevance The results of this cross-sectional study suggest that while annual use of cervical cancer screening-associated services in the Medicare fee-for-service population older than 65 years has decreased during the last 2 decades, more than 1.3 million women received these services in 2019 at substantial costs.
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Affiliation(s)
- Jin Qin
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hunter K. Holt
- Department of Family and Community Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Thomas B. Richards
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Saraiya
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - George F. Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
- UCSF Center for Healthcare Value, San Francisco, California
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25
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Breast, Colorectal, Lung, Prostate, and Cervical Cancer Screening Prevalence in a Large Commercial and Medicare Advantage Plan, 2008–2020. Prev Med Rep 2022; 30:102046. [DOI: 10.1016/j.pmedr.2022.102046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022] Open
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Mahas R, Neale AV. Cervical cancer prevention in the United States and United Kingdom: where are we now and what's next? Fam Pract 2022; 39:1183-1186. [PMID: 35348683 DOI: 10.1093/fampra/cmac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rachel Mahas
- Department of Family Medicine and Public Health Sciences, Wayne State University, 3939 Woodward, Detroit, MI 48201, United States
| | - Anne Victoria Neale
- Department of Family Medicine and Public Health Sciences, Wayne State University, 3939 Woodward, Detroit, MI 48201, United States
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Lee YW, Morgan JR, Fiascone S, Perkins RB. Underscreening, overscreening, and guideline-adherent cervical cancer screening in a national cohort. Gynecol Oncol 2022; 167:181-188. [PMID: 36150914 DOI: 10.1016/j.ygyno.2022.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore rates of under- and overscreening for cervical cancer among a national cohort. METHODS The MarketScan database, a national administrative database of employee-sponsored insurance, was queried for elements relevant to cervical cancer screening among women aged 21-65 with 6 years of continuous enrollment (2015-2019). Average-risk women were defined as those without high-risk medical conditions or abnormal screening histories, and without evidence of hysterectomy with removal of the cervix for benign indications. Average-risk women were considered adequately screened if they had Pap tests alone at 2.5-3.5 year intervals, or HPV tests or co-tests at 4.5-5.5 year intervals. Logistic regressions were used to predict the odds of receiving guideline-adherent screening, underscreening, and overscreening. RESULTS Among 1,872,809 eligible patients, 1,471,063 (78.5%) qualified for routine screening. Of these, only 18.1% received guideline-adherent screening, and 25.4% were unscreened during the 6-year period. Younger women (aged 21-39) were more likely to be overscreened [OR 1.46]. Older women (aged 50-64) were more likely to be underscreened or unscreened during the study period [OR 2.54]. Guideline-adherent screening was highest with HPV testing alone (80%) followed by co-testing (44%), and lowest with cytology alone (15%). A total of 329,062 women in this general population sample (18%) met high-risk criteria that required increased frequency of screening. CONCLUSIONS High rates of both underscreening and overscreening indicate a need for additional strategies to improve guideline-adherent care. CLINICAL TRIAL REGISTRATION N/A.
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Affiliation(s)
- Yeon Woo Lee
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America.
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States of America.
| | - Stephen Fiascone
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America.
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America.
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28
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Falk D, Foley K, Weaver KE, Jones B, Cubbin C. An Evaluation of Breast and Cervical Cancer Screening Outcomes in an Education and Patient Navigation Program in Rural and Border Texas. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1043-1052. [PMID: 33150556 PMCID: PMC8096853 DOI: 10.1007/s13187-020-01918-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 06/11/2023]
Abstract
This study examines breast and cervical cancer screening uptake in a cancer education and patient navigation (PN) program for residents of rural and border counties in Texas by level of participation (education only, PN only, or education and PN). Data collected from March 1, 2012, to November 5, 2016, included 6663 follow-up surveys from participants aged 21-74. Logistic regression models assessed program participation on the odds of completing breast or cervical cancer screening. For women aged 40-74 years (N = 4942; mean age = 52 years), 58.4% reported a mammogram within 6 months on average from initial contact. In the breast cancer screening model, women who only received PN (OR: 6.06, CI: 4.87-7.53) or who participated in both the education plus PN program (OR: 3.33, CI: 2.77-4.02) had higher odds of mammogram screening compared to women who only received education. For women aged 21-64 years (N = 6169; mean age = 46 years), 37.7% received a Papanicolaou (Pap) test within 6 months on average from initial contact. In the Pap screening model, both education and PN (OR: 3.23, CI: 2.66-3.91) and PN only (OR: 2.35, CI: 1.88-2.93) groups had higher odds of screening for cervical cancer compared to those only receiving education. Graphed predicted probabilities examined significant interactions between race/ethnicity/language and program participation (P < 0.0001) for both screenings. PN, solely or in combination with education, is an effective strategy to increase screening for breast and cervical cancer, beyond educational outreach efforts alone, among un-/underserved, racially/ethnically diverse women in rural and border Texas counties.
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Affiliation(s)
- Derek Falk
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Kristie Foley
- Department of Implementation Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Department of Implementation Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Barbara Jones
- Steve Hicks School of Social Work, The University of Texas at Austin, 1 University Station D3500, Austin, TX, 78712, USA
- Departments of Health Social Work, Oncology, Population Health, and Psychiatry, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z1100, Austin, TX, 78712, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z1100, Austin, TX, 78712, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, 1 University Station D3500, Austin, TX, 78712, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z1100, Austin, TX, 78712, USA
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Temporal Trends in Cervical Cancer Screening Practices and Associated Downstream Abnormalities and Procedures Among Women With Insurance in the United States. Obstet Gynecol 2022; 140:55-64. [DOI: 10.1097/aog.0000000000004838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
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30
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Interventions for cancer screening among Chinese Americans: A systematic review and meta-analysis. PLoS One 2022; 17:e0265201. [PMID: 35294463 PMCID: PMC8926258 DOI: 10.1371/journal.pone.0265201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background
Cancer is the leading cause of death among Chinese Americans (CAs). Although death rates of cancers can be significantly reduced by screening cancers at an early stage, cancer screening (CS) rates are low among CAs. Interventions on CS may increase the uptake rates of CS and help to decrease the death rates of cancers in CAs.
Objectives
This study aims to summarize the intervention methods on CS among CAs and compare effects of various intervention methods on the outcomes of CS, including knowledge levels of CS, intentions to complete CS, and actual completions of CS.
Methods
A systematic review and meta-analysis design was used. Keyword searching was conducted on PubMed, Google Scholar, PsycINFO, and CINAHL. Inclusion and exclusion criteria were applied. The PEDro scale was used to evaluate the quality of the studies. Data was analyzed using Review Manager Version 5.4 software. Random effect model and subgroup analyses were conducted.
Results
The search yielded 13 eligible studies. All of the reviewed interventions were culturally tailored. Systematic review results were categorized by intervention delivery objects, intervention led, intervention contact, intervention types, and intervention focus according to group consensus. Meta-analysis results showed that the interventions on CS had a positive effect on all outcomes, including a 1.58 (95% CI, 1.17–2.14; P = 0.003), 1.78 (95% CI, 1.27–2.48; P = 0.0007), and 1.72 (95% CI, 1.22–2.42; P = 0.002) effect on knowledge of CS, intentions to complete CS, and completions of CS, respectively, compared to the control group. The subgroup analysis suggested that physician-led, individual-based, face-to-face client-focused interventions with multiple components increased CS among CAs, with the OR ranging from 1.60 (95% CI, 1.08–2.39; P = 0.02) to 3.11 (95%CI, 1.02–9.49; P = 0.05).
Discussion
Interventions on CS significantly increased CAs’ knowledge of CS, intentions to complete CS, and completions of CS. Physician-led, individual-based, face-to-face client-focused interventions with multiple components should be utilized for CAs.
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Sackey ENS, Pemmaraju M, Griffin MR, Castilho JL. Impact of prior underinsurance on cervical cancer screening among Davidson County, Tennessee, women diagnosed with invasive cervical cancer, 2008-2018. BMC Womens Health 2022; 22:68. [PMID: 35279162 PMCID: PMC8918308 DOI: 10.1186/s12905-022-01638-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We sought to investigate the association between insurance coverage history and cervical cancer screening among Davidson County, Tennessee, women diagnosed with incident cervical cancer. METHODS We reviewed medical records of women diagnosed with invasive cervical cancer from 2008 through 2018 identified via the state's cancer registry and by active surveillance of diagnostic pathology reports for the HPV-IMPACT project. Per 2012 United States Preventive Services Task Force recommended cervical cancer screening guidelines, women were characterized into three screening history categories: "no screening", "no follow-up" and "test/screening failure". Multivariable logistic regression measured the association of prior inadequate insurance (underinsurance) and screening history ("no screening/no follow-up" compared to "test/screening failure"). RESULTS Of 212 women, most (77%) had not undergone recommended cervical cancer screening or follow-up prior to cancer diagnosis. Overall, 28% of women had history of underinsurance in 5 years prior to diagnosis. In adjusted analyses, underinsured women were more likely to have a "no screening/no follow-up" prior to cancer diagnosis (aOR 4.26; 95% CI 1.15-15.80) compared to "test/screening failure" history. Non-white race (aOR 2.73; 95% CI 0.98-7.61), older age (aOR 1.03 per year; 95% CI 1.00-1.07), and history of smoking (aOR 4.07; 95% CI 1.54-10.74) were also associated with increased likelihood of "no screening/no follow-up". CONCLUSIONS Previous underinsurance was independently associated with non-adherence to cervical cancer screening and follow-up guidelines among women with incident cervical cancer. Further study of factors contributing to inadequate cervical cancer screening and interventions to increase cervical cancer screening in high-risk populations is needed.
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Affiliation(s)
- Emmanuel N S Sackey
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Manideepthi Pemmaraju
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica L Castilho
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Reynolds EE, Weinstein A, Farid H, Libman H. When and How Would You Screen This Patient for Cervical Cancer? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2022; 175:267-275. [PMID: 35130045 DOI: 10.7326/m21-4372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Successful screening programs based on cervical cytology have dramatically reduced the incidence of cervical cancer in the United States. Human papillomavirus immunization is poised to reduce it further as an increasing percentage of vaccinated women reach adulthood. A recent guideline from the American Cancer Society advises that cervical cancer screening begin at age 25 and that high-risk human papillomavirus testing is the preferred screening test. The U.S. Preventive Services Task Force recommends screening begin at age 21 and that cytology remain incorporated into screening. Here, 2 experts debate how to apply these guidelines to Ms. L, a 22-year-old woman who has never undergone cervical cancer screening.
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Affiliation(s)
- Eileen E Reynolds
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (E.E.R., H.L.)
| | - Amy Weinstein
- Harvard Medical School, Boston, Massachusetts (A.W.)
| | - Huma Farid
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (H.F.)
| | - Howard Libman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (E.E.R., H.L.)
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MacLaughlin KL, Jacobson RM, St. Sauver JL, Jenkins GD, Fan C, Finney Rutten LJ. Awareness and Support of Clinician- and Patient-Collected Human Papillomavirus Testing for Cervical Cancer Screening Among Primary Care Clinicians. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:10-19. [PMID: 35136872 PMCID: PMC8812491 DOI: 10.1089/whr.2021.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Background: Cervical cancer screening has shifted toward human papillomavirus (HPV)-based testing, but uptake of primary HPV screening in the United States is unknown and previous studies highlight delays in clinician adoption of guideline updates. Methods: We conducted a cross-sectional electronic survey of primary care clinicians (n = 252; response rate = 30.9%) assessing awareness and support of primary HPV screening. We assessed factors for association with past use of HPV testing and support of clinician- and patient-collected HPV testing individually using Fisher's exact test and jointly using Firth's logistic regression. Results: Most clinicians (79%) were familiar with one or more primary HPV screening guidelines. Support for clinician-collected (89%) and patient-collected (82%) HPV testing was high, but only 34.5% reported prior use. Guideline familiarity was positively associated with HPV testing in practice (p = 0.0001). Support of clinician-collected testing was positively associated with more years in practice (p = 0.03), internal (vs. family) medicine specialty (p = 0.03), and guideline familiarity (p ≤ 0.0001). Male clinicians more frequently supported patient collection for patients overdue for screening (p = 0.013). Physicians more frequently than advanced practice providers (APPs) supported patient collection for screening-adherent women (p = 0.021). Multivariable analysis showed those unfamiliar with guidelines were less likely to have used HPV testing [odds ratio, OR: 0.10 (0.03-0.32)] or to support clinician-collected HPV testing [OR: 0.16 (0.07-0.37)]. APPs were less likely than physicians to support patient-collected HPV testing among screening-adherent women [OR: 0.42 (0.20-0.87)]. Conclusions: We observed high levels of guideline awareness and clinician support for primary HPV testing, despite relatively low use. This merits further exploration to inform future interventions to increase uptake.
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Affiliation(s)
- Kathy L. MacLaughlin
- Department of Family Medicine, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Robert M. Jacobson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
- Division of Community Pediatric and Adolescent Medicine, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Rochester, Minnesota, USA
| | - Jennifer L. St. Sauver
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Rochester, Minnesota, USA
| | | | - Chun Fan
- Department of Quantitative Health Sciences, Rochester, Minnesota, USA
| | - Lila J. Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Rochester, Minnesota, USA
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Suk R, Hong YR, Rajan SS, Xie Z, Zhu Y, Spencer JC. Assessment of US Preventive Services Task Force Guideline-Concordant Cervical Cancer Screening Rates and Reasons for Underscreening by Age, Race and Ethnicity, Sexual Orientation, Rurality, and Insurance, 2005 to 2019. JAMA Netw Open 2022; 5:e2143582. [PMID: 35040970 PMCID: PMC8767443 DOI: 10.1001/jamanetworkopen.2021.43582] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Cervical cancer screening rates are suboptimal in the US. Population-based assessment of reasons for not receiving screening is needed, particularly among women from historically underserved demographic groups. OBJECTIVE To estimate changes in US Preventive Service Task Force guideline-concordant cervical cancer screening over time and assess the reasons women do not receive up-to-date screening by sociodemographic factors. DESIGN, SETTING, AND PARTICIPANTS This pooled population-based cross-sectional study used data from the US National Health Interview Survey from 2005 and 2019. A total of 20 557 women (weighted, 113.1 million women) aged 21 to 65 years without previous hysterectomy were included. Analyses were conducted from March 30 to August 19, 2021. EXPOSURES Sociodemographic factors, including age, race and ethnicity, sexual orientation, rurality of residence, and health insurance type. MAIN OUTCOMES AND MEASURES Primary outcomes were US Preventive Services Task Force guideline-concordant cervical cancer screening rates and self-reported primary reasons for not receiving up-to-date screening. For 2005, up-to-date screening was defined as screening every 3 years for women aged 21 to 65 years. For 2019, up-to-date screening was defined as screening every 3 years with a Papanicolaou test alone for women aged 21 to 29 years and screening every 3 years with a Papanicolaou test alone or every 5 years with high-risk human papillomavirus testing or cotesting for women aged 30 to 65 years. Population estimation included sampling weights. RESULTS Among 20 557 women (weighted, 113.1 million women) included in the study, most were aged 30 to 65 years (16 219 women; weighted, 86.3 million women [76.3%]) and had private insurance (13 571 women; weighted, 75.8 million women [67.0%]). With regard to race and ethnicity, 997 women (weighted, 6.9 million women [6.1%]) were Asian, 3821 women (weighted, 19.5 million women [17.2%]) were Hispanic, 2862 women (weighted, 14.8 million women [13.1%]) were non-Hispanic Black, 12 423 women (weighted, 69.0 million women [61.0%]) were non-Hispanic White, and 453 women (weighted, 3.0 million women [2.7%]) were of other races and/or ethnicities (including Alaska Native and American Indian [weighted, 955 000 women (0.8%)] and other single and multiple races or ethnicities [weighted, 2.0 million women (1.8%)]). In 2019, women aged 21 to 29 years had a significantly higher rate of overdue screening (29.1%) vs women aged 30 to 65 years (21.1%; P < .001). In both age groups, the proportion of women without up-to-date screening increased significantly from 2005 to 2019 (from 14.4% to 23.0%; P < .001). Significantly higher rates of overdue screening were found among those of Asian vs non-Hispanic White race and ethnicity (31.4% vs 20.1%; P = .01), those identifying as LGBQ+ (gender identity was not assessed because of a small sample) vs heterosexual (32.0% vs 22.2%; P < .001), those living in rural vs urban areas (26.2% vs 22.6%; P = .04), and those without insurance vs those with private insurance (41.7% vs 18.1%; P < .001). The most common reason for not receiving timely screening across all groups was lack of knowledge, ranging from 47.2% of women identifying as LGBQ+ to 64.4% of women with Hispanic ethnicity. Previous receipt of a human papillomavirus vaccine was not a primary reason for not having up-to-date screening (<1% of responses). From 2005 to 2019, among women aged 30 to 65 years, lack of access decreased significantly as a primary reason for not receiving screening (from 21.8% to 9.7%), whereas lack of knowledge (from 45.2% to 54.8%) and not receiving recommendations from health care professionals (from 5.9% to 12.0%) increased significantly. CONCLUSIONS AND RELEVANCE This cross-sectional study found that cervical cancer screening that was concordant with US Preventive Services Task Force guidelines decreased in the US between 2005 and 2019, with lack of knowledge reported as the biggest barrier to receiving timely screening. Campaigns addressing patient knowledge and provider communication may help to improve screening rates, and cultural adaptation of interventions is needed to reduce existing disparities.
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Affiliation(s)
- Ryan Suk
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
- University of Florida Health Cancer Center, Gainesville
| | - Suja S. Rajan
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Zhigang Xie
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Yenan Zhu
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Jennifer C. Spencer
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin
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Haas JS, Cheng D, Yu L, Atlas SJ, Clark C, Feldman S, Silver MI, Kamineni A, Chubak J, Pocobelli G, Tiro JA, Kobrin SC. Variation in the receipt of human papilloma virus co-testing for cervical screening: Individual, provider, facility and healthcare system characteristics. Prev Med 2022; 154:106871. [PMID: 34762966 PMCID: PMC8724456 DOI: 10.1016/j.ypmed.2021.106871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/18/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
Since 2012, cervical cancer screening guidelines allow for choice of screening test for women age 30-65 years (i.e., Pap every 3 years or Pap with human papillomavirus co-testing every 5 years). Intended to give patients and providers options, this flexibility reflects a trend in the growing complexity of screening guidelines. Our objective was to characterize variation in cervical screening at the individual, provider, clinic/facility, and healthcare system levels. The analysis included 296,924 individuals receiving screening from 3626 providers at 136 clinics/facilities in three healthcare systems, 2010 to 2017. Main outcome was receipt of co-testing vs. Pap alone. Co-testing was more common in one healthcare system before the 2012 guidelines (adjusted odds ratio (AOR) of co-testing at the other systems relative to this system 0.00 and 0.50) but was increasingly implemented over time in a second with declining uptake in the third (2017: AORs shifted to 7.32 and 0.01). Despite system-level differences, there was greater heterogeneity in receipt of co-testing associated with providers than clinics/facilities. In the three healthcare systems, providers in the highest quartile of co-testing use had an 8.35, 8.81, and 25.05-times greater odds of providing a co-test to women with the same characteristics relative to the lowest quartile. Similarly, clinics/ facilities in the highest quartile of co-testing use had a 4.20, 3.14, and 6.56-times greater odds of providing a co-test relative to the lowest quartile. Variation in screening test use is associated with health system, provider, and clinic/facility levels even after accounting for patient characteristics.
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Affiliation(s)
- Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - David Cheng
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Liyang Yu
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Cheryl Clark
- Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Michelle I Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, United States of America
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Gaia Pocobelli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Jasmin A Tiro
- Department of Population & Data Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Sarah C Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America
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McDaniel CC, Hallam HH, Cadwallader T, Lee HY, Chou C. Disparities in Cervical Cancer Screening with HPV Test among Females with Diabetes in the Deep South. Cancers (Basel) 2021; 13:cancers13246319. [PMID: 34944937 PMCID: PMC8699065 DOI: 10.3390/cancers13246319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Diabetes is linked with poorer cervical cancer prognosis, and people residing in the Southern region of the U.S. are disproportionately diagnosed with diabetes and cancer. The HPV test was recently recognized as the preferred method of cervical cancer screening by the American Cancer Society. Through our observational study, we sought to investigate the HPV testing behaviors among females with and without diabetes across the U.S. Our nationally representative estimates reveal that less than half of females reported HPV testing, and females with diabetes in the Deep South have the lowest rates of HPV testing. Various risk factors were identified to significantly lower the odds of HPV testing, including a diabetes diagnosis, older age, living in the Southern region of the U.S., and absence of certain comorbidities. The lower rates of HPV testing among females with diabetes, especially those living in the Deep South, leave these populations vulnerable to cervical cancer. Abstract Background: Due to diabetes being linked with poorer cervical cancer prognosis, this study aimed to evaluate HPV testing behaviors among females with and without diabetes across the U.S. by geographic area in 2016, 2018, and 2020. Methods: This cross-sectional study used the Behavioral Risk Factor Surveillance System (BRFSS) from 2016, 2018, and 2020. The study population included females aged 25–69 years old, stratified by self-reported diabetes status. The primary outcome measure was cervical cancer screening behavior, which was evaluated by self-reported HPV test uptake/receipt (yes/no). Results: A total of 361,546 females from across the U.S. were sampled. Within the study population combined from all study years, the overall likelihood of receiving an HPV test was significantly lower among females with diabetes [37.95% (95% CI: 36.87–39.04)] compared to those without diabetes [46.21% (95% CI: 45.84–46.58)] (p < 0.001). Screening rates with HPV tests were lowest among females with diabetes in the South in 2016 (29.32% (95% CI: 26.82–31.83)), 2018 (39.63% (95% CI: 36.30–42.96)), and 2020 (41.02% (95% CI: 37.60–44.45)). Conclusions: Females with diabetes are screening with HPV tests less frequently than females without diabetes, and females living in the South, particularly states in the Deep South, report the lowest rates of HPV testing.
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Affiliation(s)
- Cassidi C. McDaniel
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA; (C.C.M.); (H.H.H.); (T.C.)
| | - Hayleigh H. Hallam
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA; (C.C.M.); (H.H.H.); (T.C.)
| | - Tiffany Cadwallader
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA; (C.C.M.); (H.H.H.); (T.C.)
| | - Hee-Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL 35487, USA;
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA; (C.C.M.); (H.H.H.); (T.C.)
- Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
- Correspondence:
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Dillon J, Chen L, Melamed A, St Clair CM, Hou JY, Khoury-Collado F, Gockley A, Accordino M, Hershman DL, Wright JD. Patterns of cervical cancer screening among Medicaid beneficiaries. BJOG 2021; 129:1104-1111. [PMID: 34882962 DOI: 10.1111/1471-0528.17050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cervical cancer screening guidelines have evolved over time with the incorporation of human papillomavirus (HPV) testing along with cytology. Current screening guidelines recommend cytological screening every 3 years or HPV testing with or without cytology every 5 years in women age 30-65 years. We examined the use of cervical cancer screening among average-risk Medicaid beneficiaries. DESIGN Retrospective cohort study. POPULATION Women age 30-64 years at average risk for cervical cancer who underwent cervical cancer screening with cytology, co-testing or primary HPV testing from 2013 to 2016. METHODS The IBM Watson Health Multi-State Medicaid MarketScan Database was used. Subsequent screening rates within 3 years of the index test were examined. MAIN OUTCOME MEASURE The rate of repeat cervical cancer screening was analysed using a cumulative incidence function. RESULTS A total of 265 083 patients were identified. Overall, 43.1% (n = 114 312) had index co-testing, 55.2% (n = 146 309) had cytology and 1.7% (n = 4462) had primary HPV testing. The cumulative incidence of early, repeat cervical cancer screening was 3.9% at 12 months, 22.7% at 24 months and 33.3% at 36 months. During the period from 12 to 24 months after follow up, 20.9% of women underwent repeat screening while 19.4% underwent repeat screening 24-36 months after the index test. Among women who did not undergo repeat cervical cancer screening, a yearly gynaecological examination was performed in only 16 627 (10.7%) during year 2 and in 11 116 (8.8%) during year 3. CONCLUSION Among average-risk Medicaid beneficiaries, cervical cancer screening is frequently overused. Women who do not undergo cervical cancer screening are unlikely to undergo routine gynaecological examination. TWEETABLE ABSTRACT Among average-risk Medicaid beneficiaries, cervical cancer screening is frequently overused.
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Affiliation(s)
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Caryn M St Clair
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - June Y Hou
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Melissa Accordino
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
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Aninye IO, Berry-Lawhorn JM, Blumenthal P, Felder T, Jay N, Merrill J, Messman JB, Nielsen S, Perkins R, Rowen T, Saslow D, Trimble CL, Smith-McCune K. Gaps and Opportunities to Improve Prevention of Human Papillomavirus-Related Cancers. J Womens Health (Larchmt) 2021; 30:1667-1672. [PMID: 34871035 PMCID: PMC8721503 DOI: 10.1089/jwh.2021.0507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Human papillomavirus (HPV) infections cause more than 35,900 cancers annually in the United States. Although cervical cancer is the most prevalent HPV-related malignancy in women, the virus is also responsible for a significant percentage of anal, vaginal, and vulvar cancers. A comprehensive approach to mitigating cervical cancer includes HPV vaccination (primary prevention), screening and treatment of precancerous lesions (secondary prevention), and diagnosis and treatment of invasive cancer (tertiary prevention). Although a successful strategy, there are opportunities to innovate and increase access that can also be adapted to address the unique clinical care gaps that exist with the other anogenital cancers. The Society for Women's Health Research held a series of interdisciplinary meetings and events, during which expert researchers, clinicians, patient advocates, and health care policy leaders evaluated the current landscape of HPV-related cancers and their effects on women's health. This report summarizes the discussions of this working group and areas it identified in which to address gaps in primary and secondary prevention approaches to improve access and health outcomes for women with HPV-related anogenital cancers.
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Affiliation(s)
- Irene O Aninye
- Society for Women's Health Research, Washington, District of Columbia, USA
| | - J Michael Berry-Lawhorn
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul Blumenthal
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA
| | | | - Naomi Jay
- Anal Neoplasia Clinic, Research, and Education Center, University of California San Francisco, San Francisco, California, USA
| | - Janette Merrill
- Policy Programs, American Society of Clinical Oncology, Alexandria, Virginia, USA
| | - Jenna B Messman
- University Health Center, University of Maryland, College Park, Maryland, USA
| | - Sarah Nielsen
- Human Relations, High Point University, High Point, North Carolina, USA
| | - Rebecca Perkins
- Department of Obstetrics and Gynecology, Boston University, Boston, Massachusetts, USA
| | - Tami Rowen
- Department of Obstetrics, Gynecology, and Gynecologic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Debbie Saslow
- Department of Prevention and Early Detection, American Cancer Society, Atlanta, Georgia, USA
| | - Connie Liu Trimble
- Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Karen Smith-McCune
- Department of Obstetrics, Gynecology, and Gynecologic Surgery, University of California San Francisco, San Francisco, California, USA
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Burden of cancer and changing cancer spectrum among older adults in China: Trends and projections to 2030. Cancer Epidemiol 2021; 76:102068. [PMID: 34864577 DOI: 10.1016/j.canep.2021.102068] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cancer creates considerable challenges for China with its aging population. This analysis aimed to estimate the burden of cancer and transition in cancer spectrum among older adults in China by 2030. METHODS Using data from the National Central Cancer Registry of China, we estimated annual percent change (APC) in cancer incidence and mortality rates among adults aged 60 years and above between 2006 and 2015 using joinpoint regression. We further estimated the number of new cancer cases and deaths from 2020 to 2030 based on the APC and population projections. RESULTS Although cancer incidence and mortality rates have been decreasing among older adults in China between 2006 and 2015, there were marked increases in the incidence and mortality rates of cervical (incidence: APC = 9.2%, mortality: APC = 7.6% all p < 0.05) and thyroid cancers (incidence: APC = 9.3%, p < 0.05) in older women. Between 2015 and 2030, the number of new cancer cases is projected to increase by 46% from 2.2 million to 3.2 million; cancer deaths will increase by 31% from 1.6 million to 2.1 million among older Chinese adults. In 2015, the 3 most common cancers were lung, colorectal and breast cancer in women, and lung, colorectal and stomach cancer in men. By 2030, cervical cancer is projected to be the most common cancer in women, followed by lung and thyroid cancer; prostate cancer will surpass stomach cancer to become the third most common cancer in men. In both sexes, lung, liver and stomach cancer were the top 3 leading causes of cancer deaths in 2015. In women, cervical cancer will surpass lung cancer as the leading cause of cancer deaths by 2030. CONCLUSION The growing burden of cervical, thyroid and prostate cancer among older Chinese adults represents a major shift in cancer spectrum in this population.
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Huong AKC, Tay KG, Ngu XTI. Five-Class Classification of Cervical Pap Smear Images: A Study of CNN-Error-Correcting SVM Models. Healthc Inform Res 2021; 27:298-306. [PMID: 34788910 PMCID: PMC8654336 DOI: 10.4258/hir.2021.27.4.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/23/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives Different complex strategies of fusing handcrafted descriptors and features from convolutional neural network (CNN) models have been studied, mainly for two-class Papanicolaou (Pap) smear image classification. This paper explores a simplified system using combined binary coding for a five-class version of this problem. Methods This system extracted features from transfer learning of AlexNet, VGG19, and ResNet50 networks before reducing this problem into multiple binary sub-problems using error-correcting coding. The learners were trained using the support vector machine (SVM) method. The outputs of these classifiers were combined and compared to the true class codes for the final prediction. Results Despite the superior performance of VGG19-SVM, with mean ± standard deviation accuracy and sensitivity of 80.68% ± 2.00% and 80.86% ± 0.45%, respectively, this model required a long training time. There were also false-negative cases using both the VGGNet-SVM and ResNet-SVM models. AlexNet-SVM was more efficient in terms of running speed and prediction consistency. Our findings also showed good diagnostic ability, with an area under the curve of approximately 0.95. Further investigation also showed good agreement between our research outcomes and that of the state-of-the-art methods, with specificity ranging from 93% to 100%. Conclusions We believe that the AlexNet-SVM model can be conveniently applied for clinical use. Further research could include the implementation of an optimization algorithm for hyperparameter tuning, as well as an appropriate selection of experimental design to improve the efficiency of Pap smear image classification.
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Affiliation(s)
- Audrey K C Huong
- Faculty of Electrical and Electronic Engineering, Universiti Tun Hussein Onn Malaysia, Batu Pahat, Malaysia
| | - Kim Gaik Tay
- Faculty of Electrical and Electronic Engineering, Universiti Tun Hussein Onn Malaysia, Batu Pahat, Malaysia
| | - Xavier T I Ngu
- Faculty of Electrical and Electronic Engineering, Universiti Tun Hussein Onn Malaysia, Batu Pahat, Malaysia
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Wentzensen N, Clarke MA, Perkins RB. Impact of COVID-19 on cervical cancer screening: Challenges and opportunities to improving resilience and reduce disparities. Prev Med 2021; 151:106596. [PMID: 34217415 PMCID: PMC8241689 DOI: 10.1016/j.ypmed.2021.106596] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has a major impact on a wide range of health outcomes. Disruptions of elective health services related to cervical screening, management of abnormal screening test results, and treatment of precancers, may lead to increases in cervical cancer incidence and exacerbate existing health disparities. Modeling studies suggest that a short delay of cervical screening in subjects with previously negative HPV results has minor effects on cancer outcomes, while delay of management and treatment can lead to larger increases in cervical cancer. Several approaches can mitigate the effects of disruption of cervical screening and management. HPV-based screening has higher accuracy compared to cytology, and a negative HPV result provides longer reassurance against cervical cancer; further, HPV testing can be conducted from self-collected specimens. Self-collection expands the reach of screening to underserved populations who currently do not participate in screening. Self-collection and can also provide alternative screening approaches during the pandemic because testing can be supported by telehealth and specimens collected in the home, substantially reducing patient-provider contact and risk of COVID-19 exposure, and also expanding the reach of catch-up services to address backlogs of screening tests that accumulated during the pandemic. Risk-based management allows prioritizing management of patients at highest risk of cervical cancer while extending screening intervals for those at lowest risk. The pandemic provides important lessons for how to make cervical screening more resilient to disruptions and how to reduce cervical cancer disparities that may be exacerbated due to disruptions of health services.
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Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Rebecca B Perkins
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
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Spencer JC, Brewer NT, Coyne-Beasley T, Trogdon JG, Weinberger M, Wheeler SB. Reducing Poverty-Related Disparities in Cervical Cancer: The Role of HPV Vaccination. Cancer Epidemiol Biomarkers Prev 2021; 30:1895-1903. [PMID: 34503948 PMCID: PMC8492489 DOI: 10.1158/1055-9965.epi-21-0307] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/21/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Near elimination of cervical cancer in the United States is possible in coming decades, yet inequities will delay this achievement for some populations. We sought to explore the effects of human papillomavirus (HPV) vaccination on disparities in cervical cancer incidence between high- and low-poverty U.S. counties. METHODS We calibrated a dynamic simulation model of HPV infection to reflect average counties in the highest and lowest quartile of poverty (percent of population below federal poverty level), incorporating data on HPV prevalence, cervical cancer screening, and HPV vaccination. We projected cervical cancer incidence through 2070, estimated absolute and relative disparities in incident cervical cancer for high- versus low-poverty counties, and compared incidence with the near-elimination target (4 cases/100,000 women annually). RESULTS We estimated that, on average, low-poverty counties will achieve near-elimination targets 14 years earlier than high-poverty counties (2029 vs. 2043). Absolute disparities by county poverty will decrease, but relative differences are estimated to increase. We estimate 21,604 cumulative excess cervical cancer cases in high-poverty counties over the next 50 years. Increasing HPV vaccine coverage nationally to the Healthy People 2020 goal (80%) would reduce excess cancer cases, but not alter estimated time to reach the near-elimination threshold. CONCLUSIONS High-poverty U.S. counties will likely be delayed in achieving near-elimination targets for cervical cancer and as a result will experience thousands of potentially preventable cancers. IMPACT Alongside vaccination efforts, it is important to address the role of social determinants and health care access in driving persistent inequities by area poverty.
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Affiliation(s)
- Jennifer C Spencer
- Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tamera Coyne-Beasley
- Departments of Pediatrics and Internal Medicine, Division of Adolescent Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Moss JL, Popalis M, Ramirez SI, Reedy-Cooper A, Ruffin MT. Disparities in Cancer Screening: The Role of County-Level Metropolitan Status and Racial Residential Segregation. J Community Health 2021; 47:168-178. [PMID: 34550504 DOI: 10.1007/s10900-021-01035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 12/21/2022]
Abstract
Mortality from cervical and colorectal cancers can be reduced through routine screening, which can often be accessed through primary care. However, uptake of screening in the US remains suboptimal, with disparities observed across geographic characteristics, such as metropolitan status or level of racial residential segregation. Little is known about the interaction of metropolitan status and segregation in their relationship with cancer screening. We conducted a quantitative survey of 474 women aged 45-65 in central Pennsylvania. The survey collected county-level characteristics and participant-level demographics, beliefs, cancer screening barriers, and cervical and colorectal cancer screening. We used bivariate and multivariable logistic regression to analyze relationships between metropolitan status and segregation with screening. For cervical cancer screening, 82.8% of participants were up-to-date, which did not differ by county type in the final analysis. Higher healthcare trust, higher cancer fatalism, and reporting cost as a barrier were associated with cervical cancer screening. For colorectal cancer screening, 55.4% of participants were up-to-date, which differed by county type. In metropolitan counties, segregation was not associated with colorectal cancer screening, but in non-metropolitan counties, segregation was associated with greater colorectal cancer screening. The relationship between metropolitan status and being up-to-date with colorectal, but not cervical, cancer screening varied by segregation. Other important beliefs and barriers to screening varied by county type. This research can guide future cancer screening interventions in primary care settings in underserved communities.
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Affiliation(s)
- Jennifer L Moss
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
- Department of Family and Community Medicine, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, 134 Sipe Ave., #205, MC HS72, P.O. Box 850, Hershey, PA, 17033, USA.
| | - Madyson Popalis
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Sarah I Ramirez
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Alexis Reedy-Cooper
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Mack T Ruffin
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Qin J, Shahangian S, Saraiya M, Holt H, Gagnon M, Sawaya GF. Trends in the use of cervical cancer screening tests in a large medical claims database, United States, 2013-2019. Gynecol Oncol 2021; 163:378-384. [PMID: 34507826 DOI: 10.1016/j.ygyno.2021.08.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine trends in the use of cervical cancer screening tests during 2013-2019 among commercially insured women. METHODS The study population included women of all ages with continuous enrollment each year in the IBM MarketScan commercial or Medicare supplemental databases and without known history of cervical cancer or precancer (range = 6.9-9.8 million women per year). Annual cervical cancer screening test use was examined by three modalities: cytology alone, cytology plus HPV testing (cotesting), and HPV testing alone. Trends were assessed using 2-sided Poisson regression. RESULTS Use of cytology alone decreased from 34.2% in 2013 to 26.4% in 2019 among women aged 21-29 years (P < .0001). Among women aged 30-64 years, use of cytology alone decreased from 18.9% in 2013 to 8.6% in 2019 (P < .0001), whereas cotesting use increased from 14.9% in 2013 to 19.3% in 2019 (P < .0001). Annual test use for HPV testing alone was below 0.5% in all age groups throughout the study period. Annually, 8.7%-13.6% of women aged 18-20 years received cervical cancer screening. There were persistent differences in screening test use by metropolitan residence and census regions despite similar temporal trends. CONCLUSIONS Temporal changes in the use of cervical cancer screening tests among commercially insured women track changes in clinical guidelines. Screening test use among individuals younger than 21 years shows that many young women are inappropriately screened for cervical cancer.
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Affiliation(s)
- Jin Qin
- Division of Cancer Prevention and Control, CDC, USA.
| | | | - Mona Saraiya
- Division of Cancer Prevention and Control, CDC, USA
| | - Hunter Holt
- Department of Family and Community Medicine, University of California, San Francisco, USA
| | | | - George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA
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46
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Heidemann DL, Adhami A, Nair A, Haftka-George A, Zaidan M, Seshadri V, Tang A, Willens DE. Using a Frontline Staff Intervention to Improve Cervical Cancer Screening in a Large Academic Internal Medicine Clinic. J Gen Intern Med 2021; 36:2608-2614. [PMID: 33987788 PMCID: PMC8390589 DOI: 10.1007/s11606-021-06865-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cervical cancer is the third most common malignancy affecting women. Screening with Papanicolaou (Pap) tests effectively identifies precancerous lesions and early-stage cervical cancer. While the nationwide rate of cervical cancer screening (CCS) is 84%, our urban general internal medicine (GIM) clinic population had a CCS rate of 70% in 2016. OBJECTIVE To improve our clinic's CCS rate to match or exceed the national average within 18 months by identifying barriers and testing solutions. DESIGN A quality improvement project led by a multidisciplinary group of healthcare providers. PARTICIPANTS Our GIM clinic includes 16 attending physicians, 116 resident physicians, and 20 medical assistants (MAs) with an insured and underserved patient population. INTERVENTION Phase 1 lasted 9 months and implemented CCS patient outreach, patient financial incentives, and clinic staff education. Phase 2 lasted 9 months and involved a workflow change in which MAs identified candidates for CCS during patient check-in. Feedback spanned the entire study period. MAIN MEASURES Our primary outcome was the number of Pap tests completed per month during the 2 study phases. Our secondary outcome was the clinic population's CCS rate for all eligible clinic patients. KEY RESULTS After interventions, the average number of monthly Pap tests increased from 35 to 56 in phase 1 and to 75 in phase 2. Of 385 patients contacted in phase 1, 283 scheduled a Pap test and 115 (41%) completed it. Compared to baseline, both interventions improved cervical cancer screening (phase 1 relative risk, 1.86; 95% CI, 1.64-2.10; P < 0.001; phase 2 relative risk, 2.70; 95% CI, 2.40-3.02; P < 0.001). Our clinic's CCS rate improved from 70% to 75% after the 18-month intervention. CONCLUSIONS The rate of CCS increased by 5% after a systematic 2-phase organizational intervention that empowered MAs to remind, identify, and prepare candidates during check-in for CCS.
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Affiliation(s)
- Danielle L Heidemann
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA.
| | - Angie Adhami
- Department of Primary Care, Dedicated Senior Medical Center, St. Petersburg, FL, USA
| | - Anupama Nair
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
| | - Alexis Haftka-George
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
| | - Mariam Zaidan
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
| | - Vaidehi Seshadri
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
| | - Amy Tang
- Department of Public Health Sciences, Detroit, MI, USA
| | - David E Willens
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
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47
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Farr MA, Joshi TP, Lewis DJ. Trends in cervical cancer screening from 2007 to 2016: association with decreased genital melanoma detection in females. Int J Dermatol 2021; 61:e326-e327. [PMID: 34403502 DOI: 10.1111/ijd.15859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Morgan A Farr
- ¹School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Tejas P Joshi
- ¹School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Daniel J Lewis
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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48
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Cuzick J, Du R, Adcock R, Kinney W, Joste N, McDonald RM, English K, Torres SM, Saslow D, Wheeler CM. Uptake of co-testing with HPV and cytology for cervical screening: A population-based evaluation in the United States. Gynecol Oncol 2021; 162:555-559. [PMID: 34253387 DOI: 10.1016/j.ygyno.2021.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Human papillomavirus (HPV) testing for cervical screening has been shown to increase the yield of precancerous disease and reduce the incidence of cervical cancer more than cytology alone. Here we document the state-wide uptake of co-testing with HPV and cytology in women aged 30-64 years as recommended by national and international bodies. METHODS Registry-based study of all screening cytology and HPV tests in New Mexico from 2008 to 2019 among women aged 21-64 years, with a focus on cytology negative tests to distinguish co-testing from reflex HPV testing to triage equivocal or mildly abnormal cytology. RESULTS A total of 1,704,055 cervical screening tests from 681,440 women aged 21-64 years in the state of New Mexico were identified. The proportion of screening tests which were co-tests rose from 5.6% in 2008 to 84.3% in 2019 among women aged 30-64 years with a marked change from the near exclusive use of the Hybrid Capture II HPV test, (a signal amplified test method) to the use of target amplified HPV tests. The largest increases were seen between 2013 and 2015, reflecting the introduction and adoption of new clinical guidelines. Increases in co-testing were also seen in younger women. CONCLUSIONS Co-testing is now well established in women aged 30-64 years, but smaller increases have also been seen at younger ages, although this is not currently recommended. The impact of co-testing on cervical disease outcomes and number of colposcopies and biopsies in routine population settings remain important, especially in young women.
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Affiliation(s)
- Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Ruofei Du
- University of New Mexico (UNM) Comprehensive Cancer Center, Department of Internal Medicine, Division of Molecular Medicine, Albuquerque, NM, USA
| | - Rachael Adcock
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | - Nancy Joste
- UNM Health Sciences Center (HSC), Department of Pathology, Albuquerque, NM, USA
| | - Ruth M McDonald
- UNM Health Sciences Center (HSC), Department of Pathology, Albuquerque, NM, USA; UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
| | | | | | - Cosette M Wheeler
- UNM Health Sciences Center (HSC), Department of Pathology, Albuquerque, NM, USA; UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, USA.
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49
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Hatta MNA, Mohamad Hanif EA, Chin SF, Neoh HM. Pathogens and Carcinogenesis: A Review. BIOLOGY 2021; 10:533. [PMID: 34203649 PMCID: PMC8232153 DOI: 10.3390/biology10060533] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
Cancer is a global health problem associated with genetics and unhealthy lifestyles. Increasingly, pathogenic infections have also been identified as contributors to human cancer initiation and progression. Most pathogens (bacteria, viruses, fungi, and parasites) associated with human cancers are categorized as Group I human carcinogens by the International Agency for Research on Cancer, IARC. These pathogens cause carcinogenesis via three known mechanisms: persistent infection that cause inflammation and DNA damage, initiation of oncogene expression, and immunosuppression activity of the host. In this review, we discuss the carcinogenesis mechanism of ten pathogens, their implications, and some future considerations for better management of the disease. The pathogens and cancers described are Helicobacter pylori (gastric cancer), Epstein-Barr virus (gastric cancer and lymphoma), Hepatitis B and C viruses (liver cancer), Aspergillus spp. (liver cancer), Opisthorchis viverrine (bile duct cancer), Clonorchis sinensis (bile duct cancer), Fusobacterium nucleatum (colorectal cancer), Schistosoma haematobium (bladder cancer); Human Papillomavirus (cervical cancer), and Kaposi's Sarcoma Herpes Virus (Kaposi's sarcoma).
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Affiliation(s)
| | | | | | - Hui-min Neoh
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Jalan Ya’acob Latiff, Cheras, Kuala Lumpur 56000, Malaysia; (M.N.A.H.); (E.A.M.H.); (S.-F.C.)
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50
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Deshmukh AA, Suk R, Shiels MS, Damgacioglu H, Lin YY, Stier EA, Nyitray AG, Chiao EY, Nemutlu GS, Chhatwal J, Schmeler K, Sigel K, Sonawane K. Incidence Trends and Burden of Human Papillomavirus-Associated Cancers Among Women in the United States, 2001-2017. J Natl Cancer Inst 2021; 113:792-796. [PMID: 32833021 PMCID: PMC8168114 DOI: 10.1093/jnci/djaa128] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/03/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023] Open
Abstract
Human papillomavirus (HPV)-associated anal and oropharyngeal cancer incidence has increased in recent years among US women. However, trends in incidence and burden (annual number of cases) of noncervical HPV-associated cancers relative to cervical cancer remain unclear. Using the 2001-2017 US cancer statistics dataset, we evaluated contemporary incidence trends and burden (annual number of cases) of HPV-associated cancers among women by anatomic site, race or ethnicity, and age. Overall, cervical cancer incidence plateaued among White women but continued to decline among Black and Hispanic women. Anal cancer incidence surpassed cervical cancer incidence among White women aged 65-74 years of age (8.6 and 8.2 per 100 000 in 2015) and 75 years or older (6.2 and 6.0 per 100 000 in 2014). The noncervical cancer burden (n = 11 871) surpassed the cervical cancer burden (n = 11 527) in 2013. Development of efficacious screening strategies for noncervical cancers and continued improvement in cervical cancer prevention are needed to combat HPV-associated cancers among women.
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Affiliation(s)
- Ashish A Deshmukh
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
| | - Ryan Suk
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Haluk Damgacioglu
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
| | - Yueh-Yun Lin
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
| | - Elizabeth A Stier
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Alan G Nyitray
- Clinical Cancer Center/Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth Y Chiao
- Department of General Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Gizem S Nemutlu
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Kathleen Schmeler
- Department of Gynecological Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Keith Sigel
- Department of General Internal Medicine, Mt. Sinai Icahn School of Medicine, New York, NY, USA
- Department of Medicine, Mt. Sinai Icahn School of Medicine, New York, NY, USA
| | - Kalyani Sonawane
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
- Center for Healthcare Data, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
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