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Tekpor E, Effah K, Sifa J, Amuah JE, Essel NOM, Kemawor S, Wormenor CM, Sesenu E, Danyo S, Akakpo PK. Prevalence of high-risk human papillomavirus infection and cervical lesions among female migrant head porters (kayayei) in Accra, Ghana: a pilot cross-sectional study. BMC Public Health 2024; 24:659. [PMID: 38429784 PMCID: PMC10905842 DOI: 10.1186/s12889-024-18094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/14/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Little attention has been given to the risk of high-risk human papillomavirus (hr-HPV) infection and cervical precancerous lesions among female migrant head porters (kayayei) in Ghana, as a vulnerable group, and to promote cervical screening in these women. This pilot study aimed to determine the prevalence of hr-HPV infection and cervical lesions among kayayei in Accra, the capital of the Greater Accra Region of Ghana and to describe our approach to triaging and treating these women. METHODS This descriptive cross-sectional cohort study involved the screening of 63 kayayei aged ≥ 18 years at the Tema Station and Agbogbloshie markets in March 2022 and May 2022. Concurrent hr-HPV DNA testing (with the MA-6000 platform) and visual inspection with acetic acid (VIA) was performed. We present prevalence estimates for hr-HPV DNA positivity and VIA 'positivity' as rates, together with their 95% confidence intervals (CIs). We performed univariate and multivariable nominal logistic regression to explore factors associated with hr-HPV infection. RESULTS Gross vulvovaginal inspection revealed vulval warts in 3 (5.0%) and vaginal warts in 2 (3.3%) women. Overall, the rate of hr-HPV positivity was 33.3% (95% CI, 21.7-46.7), whereas the VIA 'positivity' rate was 8.3% (95% CI, 2.8-18.4). In the univariate logistic regression analysis, none of the sociodemographic and clinical variables assessed, including age, number of prior pregnancies, parity, past contraceptive use, or the presence of abnormal vaginal discharge showed statistically significant association with hr-HPV positivity. After controlling for age and past contraceptive use, only having fewer than two prior pregnancies (compared to having ≥ 2) was independently associated with reduced odds of hr-HPV infection (adjusted odds ratio, 0.11; 95% CI, 0.02-0.69). CONCLUSION In this relatively young cohort with a high hr-HPV positivity rate of 33.3% and 8.3% of women showing cervical lesions on visual inspection, we posit that kayayei may have an increased risk of developing cervical cancer if their accessibility to cervical precancer screening services is not increased.
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Affiliation(s)
- Ethel Tekpor
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
| | - Kofi Effah
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
| | - Jerry Sifa
- University Health Services, University of Ghana, Accra, Ghana
| | - Joseph Emmanuel Amuah
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nana Owusu Mensah Essel
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana.
- Department of Emergency Medicine, College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, 730 University Terrace, T6G 2T4, Edmonton, AB, Canada.
| | - Seyram Kemawor
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
| | | | - Edna Sesenu
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
| | - Stephen Danyo
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
| | - Patrick Kafui Akakpo
- Department of Pathology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Enden MR, Møen K, Igland J, Diaz E. Trends in cervical cancer screening in Norway 2012-2017: a comparison study of non-immigrant and immigrant women. Scand J Public Health 2024:14034948231217636. [PMID: 38166571 DOI: 10.1177/14034948231217636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
AIMS Immigrant women in Norway have lower cervical cancer screening participation than non-immigrant women. Our aim in this study was to assess whether the observed increase in screening participation during 2012-2017 was different between Norwegian-born women and immigrant women. METHODS Data were collected from three national registries. The study included 1,409,561 women, categorized according to country of birth and immigrant background: (i) Norway, Norwegian parents; (ii) Norway, immigrant parent(s); (iii) Europe, excluding Norway; (iv) Africa; (v) Asia, including Turkey; and (vi) other countries. Trends and differences between groups were analyzed using Poisson regression analyses with adjustments for variables other studies have found to influence screening participation. Trends were assessed by including half-years as a continuous variable in the models and reported as prevalence ratios with 95% confidence intervals. RESULTS Screening participation increased in all groups, but was not statistically significant among women from Africa in the adjusted model. The highest increase was among Norwegian women, with a 2.2% increase per year. Interaction tests showed significantly smaller increases in screening among women born in Europe (p interaction < 0.0001), Africa (p interaction < 0.0001), Asia (p interaction < 0.0001), and countries in the "Other" category (p interaction = 0.004). There was also a smaller increase among Norwegian-born women with one or more immigrant parent(s), but this was not significant (p interaction = 0.178). CONCLUSIONS The gap in screening participation and the increasing differences in trends suggest that healthcare services do not reach all women in Norway to the same extent. One should attempt to improve this while working toward further increasing screening participation for all.
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Affiliation(s)
- Marta Røttingen Enden
- Institute of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
| | - Kathy Møen
- Institute of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
| | - Jannicke Igland
- Institute of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
| | - Esperanza Diaz
- Institute of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
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Visioli CB, Giorgi Rossi P, Armaroli P, Iossa A, Rizzolo R, Bonelli LA, Venturino E, Carozzi FM, Bisanzi S, De Marco L, Giordano L, Camussi E, Del Mistro A, Zappa M. The Consensus Project: Participation in cervical cancer screening by the first cohorts of girls offered HPV vaccination at age 15-16 years in Italy. J Med Screen 2023; 30:142-149. [PMID: 36999190 DOI: 10.1177/09691413231165237] [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] [Indexed: 04/01/2023]
Abstract
OBJECTIVE To evaluate the association between human papillomavirus vaccination status and participation in cervical cancer screening (at age 25) by the first cohorts of girls who were offered vaccination at the age of 15 to 16 years in Italy. METHODS Women born in 1993, 1994 and 1995 were invited to participate in cervical cancer screening between 2018 and 2020. We report participation in screening by vaccination status in three large areas, Florence province, Piedmont region and Savona province, where the Consensus Project was carried out. The relative risk of participation among vaccinated (≥2 doses) and unvaccinated women was estimated. Odds ratios (OR) of participation by vaccination status were estimated by logistic regression, adjusted by birthplace and birth cohort. RESULTS Overall, 34,993 women were invited for screening: 13,006 (37.2%) participated and 10,062 of these agreed to participate in the Consensus intervention study. Among the invited women and screening participants, vaccinated women were 51.0% and 60.6%, respectively. Comparing vaccinated and unvaccinated women, the adjusted OR of screening participation was 1.80 (95% confidence interval (CI): 1.72-1.89), 2.17 (95% CI: 1.94-2.42), 1.59 (95% CI: 1.50-1.68) and 1.15 (95% CI: 0.86-1.54) for overall, Florence, Piedmont and Savona, respectively. About 33% of the invited women were unvaccinated and did not participate in screening: 25.8%, 59.5% and 64.2% of women born in Italy, in high migration pressure countries and in advanced development countries, respectively. CONCLUSIONS Screening participation was higher among vaccinated than unvaccinated women. Active policies are needed to reduce inequalities, targeting the unscreened and unvaccinated population, particularly non-native women, to accelerate cervical cancer elimination in Italy.
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Affiliation(s)
- Carmen B Visioli
- Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paola Armaroli
- Cancer Epidemiology Unit and Centre for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Anna Iossa
- Screening and Secondary Prevention Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Raffaella Rizzolo
- Cancer Epidemiology Unit and Centre for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Luigina A Bonelli
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ezio Venturino
- Pathological Anatomy Unit, ASL2 Liguria, San Paolo Hospital, Savona, Italy
| | - Francesca M Carozzi
- Regional Laboratory for Cancer Prevention, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Simonetta Bisanzi
- Regional Laboratory for Cancer Prevention, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Laura De Marco
- Cancer Epidemiology Unit and Centre for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Livia Giordano
- Cancer Epidemiology Unit and Centre for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Elisa Camussi
- Cancer Epidemiology Unit and Centre for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Annarosa Del Mistro
- Immunology and Molecular Oncology Diagnostics, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marco Zappa
- Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
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Tolosko JA, Beauchesne M, Rancatore E. Knowledge, attitudes, and practice of the Pap smear test in female college students attending a global university in the United States. J Am Assoc Nurse Pract 2023; 35:322-329. [PMID: 36862575 DOI: 10.1097/jxx.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND According to the World Health Organization, every minute, one woman is diagnosed with cervical cancer, and every 2 minutes, one woman dies of cervical cancer globally (World Health Organization, 2022). The biggest tragedy is 99% of cervical cancer is caused by a preventable sexually transmitted infection known as human papilloma virus (World Health Organization, 2022). LOCAL PROBLEM Many US universities indicate approximately 30% of their admissions are international students. The lack of Pap smear screening in this population has not been clearly identified by college health care providers. METHODS Fifty-one participants from a university located in the northeastern United States completed an online survey between September and October 2018. The survey was designed to identify disparities between United States residents and internationally admitted female students in their knowledge, attitudes, and practice of the Pap smear test. INTERVENTIONS One hundred percent of US students had heard of the Pap smear test as compared with 72.7% of international students ( p = .008); 86.8% of US students considered a Pap smear as opposed to 45.5% of international students ( p = .002), and 65.8% of US students previously had a Pap smear test as opposed to 18.8% of international students ( p = .007). RESULTS Results revealed statistically significant differences between US and internationally admitted female college students in knowledge, attitudes, and practice of the Pap smear test. CONCLUSIONS This project helps to bring awareness to college health clinicians the need for cervical cancer education and Pap smear screening for our college age international female population.
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Affiliation(s)
| | | | - Elaine Rancatore
- University Health Services at Northeastern University, Boston, MA
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Collatuzzo G, La Vecchia C, Parazzini F, Alicandro G, Turati F, Di Maso M, Malvezzi M, Pelucchi C, Negri E, Boffetta P. Cancers attributable to infectious agents in Italy. Eur J Cancer 2023; 183:69-78. [PMID: 36801622 DOI: 10.1016/j.ejca.2023.01.010] [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: 11/10/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To provide an evidence-based, comprehensive assessment of the current burden of infection-related cancers in Italy. METHODS We calculated the proportion of cancers attributable to infectious agents (Helicobacter pylori [Hp]; hepatitis B virus [HBV] and hepatitis C virus [HCV]; human papillomavirus [HPV]; human herpesvirus-8 [HHV8]; Epstein-Barr virus [EBV]; and human immunodeficiency virus [HIV]) to estimate the burden of infection-related cancer incidence (2020) and mortality (2017). Data on the prevalence of infections were derived from cross-sectional surveys of the Italian population, and relative risks from meta-analyses and large-scale studies. Attributable fractions were calculated based on the counterfactual scenario of a lack of infection. RESULTS We estimated that 7.6% of total cancer deaths in 2017 were attributable to infections, with a higher proportion in men (8.1%) than in women (6.9%). The corresponding figures for incident cases were 6.5%, 6.9% and 6.1%. Hp was the first cause of infection-related cancer deaths (3.3% of the total), followed by HCV (1.8%), HIV (1.1%), HBV (0.9%), HPV, EBV and HHV8 (each ≤0.7%). Regarding incidence, 2.4% of the new cancer cases were due to Hp, 1.3% due to HCV, 1.2% due to HIV, 1.0% due to HPV, 0.6% due to HBV and <0.5% due to EBV and HHV8. CONCLUSIONS Our estimate of 7.6% of cancer deaths and 6.9% of incident cases that were attributable to infections in Italy is higher than those estimated in other developed countries. Hp is the major cause of infection-related cancer in Italy. Prevention, screening and treatment policies are needed to control these cancers, which are largely avoidable.
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Affiliation(s)
- Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy; Department of Obstetrics, Gynecology, and Neonatology, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Turati
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Matteo Malvezzi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA.
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Liang LA, Zeissig SR, Schauberger G, Merzweiler S, Radde K, Fischbeck S, Ikenberg H, Blettner M, Klug SJ. Colposcopy non-attendance following an abnormal cervical cancer screening result: a prospective population-based cohort study. BMC Womens Health 2022; 22:285. [PMID: 35810270 PMCID: PMC9270801 DOI: 10.1186/s12905-022-01851-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background A considerable proportion of cervical cancer diagnoses in high-income countries are due to lack of timely follow-up of an abnormal screening result. We estimated colposcopy non-attendance, examined the potential factors associated and described non-attendance reasons in a population-based screening study. Methods Data from the MARZY prospective cohort study were analysed. Co-test screen-positive women (atypical squamous cells of undetermined significance or worse [ASC-US+] or high-risk human papillomavirus [hrHPV] positive) aged 30 to 65 years were referred to colposcopy within two screening rounds (3-year interval). Women were surveyed for sociodemographic, HPV-related and other data, and interviewed for non-attendance reasons. Logistic regression was used to examine potential associations with colposcopy attendance. Results At baseline, 2,627 women were screened (screen-positive = 8.7%), and 2,093 again at follow-up (screen-positive = 5.1%; median 2.7 years later). All screen-positives were referred to colposcopy, however 28.9% did not attend despite active recall. Among co-test positives (ASC-US+ and hrHPV) and only hrHPV positives, 19.6% were non-attendees. Half of only ASC-US+ screenees attended colposcopy. Middle age (adjusted odds ratio [aOR] = 1.55, 95% CI 1.02, 4.96) and hrHPV positive result (aOR = 3.04, 95% CI 1.49, 7.22) were associated with attendance. Non-attendance was associated with having ≥ 3 children (aOR = 0.32, 95% CI 0.10, 0.86). Major reasons for non-attendance were lack of time, barriers such as travel time, need for childcare arrangements and the advice against colposcopy given by the gynaecologist who conducted screening. Conclusions Follow-up rates of abnormal screening results needs improvement. A systematic recall system integrating enhanced communication and addressing follow-up barriers may improve screening effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01851-6.
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Frick A, Azuaga A, Abdulcadir J. Cervical dysplasia among migrant women with female genital mutilation/cutting type III: A cross-sectional study. Int J Gynaecol Obstet 2022; 157:557-563. [PMID: 34498291 PMCID: PMC9293473 DOI: 10.1002/ijgo.13921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE To assess the rate of cervical dysplasia in a population of migrant women with female genital mutilation/cutting (FGM/C) type III who attended a specialized clinic for FGM/C. METHODS Descriptive retrospective cross-sectional study reviewing electronic medical records of all infibulated women who attended a specialized clinic for women and girls with FGM/C at Geneva University Hospitals (2010-2016). We examined sociodemographic characteristics, parity, FGM/C subtypes, presence/grade of cervical dysplasia, colposcopy follow up/treatment, infections, and history of sexual violence. RESULTS Out of 360 women reviewed, 188 women with FGM/C type III were included. Mean age of the women was 37.7 (±5.14) years. They were mostly from East Africa (n = 116, 61.7%). A total of 113 (60%) had undergone defibulation, the majority (105; 92.9%) without undergoing re-infibulation. Cervical dysplasia was found in 20 (10.6%): 16 (8.5%) had a low-grade grade squamous intraepithelial lesion or HPV-positive atypical squamous cells of undetermined significance, Four (2.1%) had a high-grade squamous intraepithelial lesions, of which one was a carcinoma in situ. Seven (35%) of the women with dysplasia underwent colposcopies regularly, five (25%) irregularly, and eight (40%) dropped out of colposcopy follow up. CONCLUSION Cervical dysplasia is frequent among women with FGM/C type III and efforts should be made to guarantee follow up for migrant women.
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Affiliation(s)
| | - Alicia Azuaga
- Department of Pediatrics, Gynecology and ObstetricsGeneva University HospitalsGenevaSwitzerland
| | - Jasmine Abdulcadir
- Department of Pediatrics, Gynecology and ObstetricsGeneva University HospitalsGenevaSwitzerland
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An Intersectional Perspective on the Utilization of Cervical Cancer Screening among Migrants. A Cross-Sectional Analysis of Survey Data from Austria. Cancers (Basel) 2021; 13:cancers13236082. [PMID: 34885190 PMCID: PMC8657384 DOI: 10.3390/cancers13236082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Studies from several countries have shown that migrant women utilize cervical cancer screening less frequently than non-migrant women. Little is known about how disparities differ across different countries of origin. The present study addresses this limitation by means of 2019 survey data from Austria. Comparing the five largest groups of migrants residing in the country, the results show that particularly Turkish migrant women have a lower utilization than the Austrian majority population. This illustrates the heterogeneity of migrants and likely results from different obstacles some groups of migrants encounter in the health system. The findings may contribute to raising the awareness of the heterogeneity of the migrant population and to providing cancer screening interventions tailored to different cultural backgrounds, consequently improving overall access to cancer screening for particularly disadvantaged and vulnerable population groups. Abstract In most European countries, migrant women have lower rates of cervical cancer screening utilization than non-migrant women. While studies have illustrated that disparities can be partially explained by social determinants, they usually did not take into account the heterogeneity of the migrant population in terms of cultural background or country of origin. Applying an intersectional approach and using 2019 data from a representative survey from Austria on 6228 women aged 20–69 years, the present study examines differences in the utilization of cervical cancer screening in the five largest migrant groups (i.e., individuals with a nationality from or born in a Yugoslav successor state, Turkey, Romania, Hungary, or Germany) residing in Austria. By means of a multivariable analysis, amongst others adjusted for socioeconomic and health-related determinants, it is illustrated that particularly Turkish migrant women have a lower utilization than the Austrian majority population (adjusted odds ratio (OR) = 0.60; 95% confidential interval (CI): 0.40–0.91), while no significant differences between the majority population and other groups of migrants became evident. The findings are indicative of the heterogeneity of migrants and likely result from different obstacles some groups of migrants encounter in the health system. This heterogeneity must be taken into account in order to support informed decision-making and to ensure adequate preventive care.
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Barriers and Facilitators to Cervical Screening among Migrant Women of African Origin: A Qualitative Study in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207473. [PMID: 33066565 PMCID: PMC7602139 DOI: 10.3390/ijerph17207473] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022]
Abstract
Globally, cervical cancer constitutes a substantial public health concern. Evidence recommends regular cervical cancer screening (CCS) for early detection of "precancerous lesions."Understanding the factors influencing screening participation among various groups is imperative for improving screening protocols and coverage. This study aimed to explore barriers and facilitators to CCS participation in women of Nigerian, Ghanaian, Cameroonian, and Kenyan origin in Finland. We utilized a qualitative design and conducted eight focus group discussions (FGDs) in English, with women aged 27-45 years (n = 30). The FGDs were tape-recorded, transcribed verbatim, and analyzed utilizing the inductive content analysis approach. The main barriers to CCS participation included limited language proficiency, lack of screening awareness, misunderstanding of screening's purpose, and miscomprehension of the CCS results. Facilitators were free-of-charge screening, reproductive health services utilization, and women's understanding of CCS's importance for early detection of cervical cancer. In conclusion, among women, the main barriers to CCS participation were language difficulties and lack of screening information. Enhancing screening participation amongst these migrant populations would benefit from appropriate information about the CCS. Those women with limited language skills and not utilizing reproductive health services need more attention from healthcare authorities about screening importance. Culturally tailored screening intervention programs might also be helpful.
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Marques P, Nunes M, Antunes MDL, Heleno B, Dias S. Factors associated with cervical cancer screening participation among migrant women in Europe: a scoping review. Int J Equity Health 2020; 19:160. [PMID: 32917224 PMCID: PMC7488650 DOI: 10.1186/s12939-020-01275-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/02/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cervical cancer screening has been effective in reducing incidence and mortality of cervical cancer, leading European countries to implement screening programs. However, migrant women show lower screening participation compared to nationals. This scoping review aims to provide a synthesis of the growing evidence on factors associated with participation in cervical cancer screening among migrant women in Europe. METHODS Electronic peer-reviewed databases were searched in November 2019 for studies on factors related to the participation of migrants in cervical cancer screening conducted in EU/EFTA countries, using comprehensive search expressions. Retrieved articles were screened and those eligible were selected for data extraction. Quantitative and qualitative studies were included. Factors were classified in barriers and facilitators and were divided into further categories. RESULTS Twenty out of 96 articles were selected and analyzed. Factors associated with participation in cervical cancer screening were classified in categories related to sociodemographic, healthcare-system, psychological, migration, knowledge, language, and cultural factors. Lack of information, lack of female healthcare providers, poor language skills, and emotional responses to the test (especially fear, embarrassment and discomfort) were the most reported barriers to cervical cancer screening. Encouragement from healthcare providers and information available in migrants' languages were frequently stated as facilitators. Results on the role of sociodemographic factors, such as age, education, employment and marital status, are the most conflicting, highlighting the complexity of the issue and the possibility of interactions between factors, resulting in different effects on cervical cancer screening participation among migrant women. Several identified barriers to screening are like those to access to healthcare services in general. CONCLUSIONS Efforts to increase migrant women's participation in CCS must target barriers to access to healthcare services in general but also specific barriers, including cultural differences about sexuality and gender, past traumatic personal experiences, and the gender and competences of healthcare professionals performing CCS. Healthcare services should strengthen resources to meet migrants' needs, including having CCS information translated and culturally adapted, as well as healthcare providers with skills to deal with cultural background. These findings can contribute to improve CCS programs among migrant women, reducing health disparities and enhancing their overall health and well-being.
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Affiliation(s)
- Patrícia Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Mariana Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria da Luz Antunes
- ESTeSL (Instituto Politécnico de Lisboa), Lisbon, Portugal
- APPsyCI - Applied Psychology Research Center Capabilities & Inclusion, ISPA, Lisbon, Portugal
| | - Bruno Heleno
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal.
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Immigration, screening, and cervical cancer incidence: an application of Age-Period-Cohort analysis. Eur J Cancer Prev 2020; 28:529-536. [PMID: 30431461 PMCID: PMC6784855 DOI: 10.1097/cej.0000000000000495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cervical cancer (CC) control is based on the implementation of effective screening programs. In the coming years, human papilloma virus vaccination coverage will contribute considerably toward cancer prevention. In Italy, where an organized screening program has been implemented, immigration from low/middle-income countries with a high prevalence of human papilloma virus infections has increased steadily over the last decades. To assess the impact of screening efforts in counteracting background changes, we analyzed the incidence trends of cervical intraepithelial neoplasia grade 3 carcinomas in situ (CIS) and invasive CC from 1994 to 2013 through an Age–Period–Cohort model using data of a regional population-based registry. Moreover, using Joinpoint regression, we compared the incidence of cervical lesions in native women with that observed in foreign-born women, highlighting the differences in age and screening status. The results indicate that the CC incidence trend decreased in Italian women (annual percent change = −2.7*%, 95% confidence interval = −4.3; −1.1), but increased (APC = 12.2*%, 95% confidence interval = 7.6; 17.0) in immigrants. For CIS, incidence rates show a growing trend in both groups, especially in women born abroad. For cancer, no marked changes in period-specific incidence rate ratios were detected until around 2000, when we found a slight decrease, followed by an increase. For CIS, we estimate an important upward trend in cohort-specific risks. The favorable effect of screening in preventing an increase in CC incidence has been counteracted by the progressive increase in immigrants from high-risk countries, where it is of increasing relevance to extend the use of vaccination.
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Møen KA, Kumar B, Igland J, Diaz E. Effect of an Intervention in General Practice to Increase the Participation of Immigrants in Cervical Cancer Screening: A Cluster Randomized Clinical Trial. JAMA Netw Open 2020; 3:e201903. [PMID: 32236530 PMCID: PMC7113727 DOI: 10.1001/jamanetworkopen.2020.1903] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Immigrant women have lower participation in cervical cancer screening (CCS) programs. At the same time, some groups of immigrants have higher prevalence of cervical cancer. Targeted interventions are therefore necessary. OBJECTIVE To determine whether an intervention among general practitioners (GPs) could influence immigrant women's participation in the Norwegian CCS program. DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized clinical trial using the 20 subdistricts of the Bergen, Norway, municipality as clusters. The clusters were matched in 10 pairs according to the number of immigrant women living in them and randomized thereafter. The intervention was implemented between January and June 2017 among urban, primary care, general practices in Bergen. Follow-up ended in January 2018. General practices belonging to the control areas continued treatment as usual. A total of 10 360 women who attended 73 general practices in the 20 subdistricts were included as participants. INTERVENTION The intervention consisted of 3 elements: an educational session for GPs at lunch describing the importance of CCS among immigrants and giving advice about how to invite them to participate, a mouse pad as a reminder, and a poster placed in waiting rooms. In the educational session, we elaborated the need for GPs to ask every immigrant woman about CCS, regardless of their reason for contacting their GP. MAIN OUTCOMES AND MEASURES The main outcome, screening status of immigrant women by January 1, 2018, was obtained from the Norwegian Cancer Registry. The effect of the intervention was measured as odds ratio (OR) for CCS status as of January 1, 2018, for the intervention group vs the control group, with 3 levels of adjustments: baseline CCS status at January 1, 2017 (model 1), additional adjustment for women's age, marital status, income level, and region of origin (model 2), and further adjustment for the GP's sex, age, and region of origin (model 3). Two subgroup analyses, screening status at baseline and women's country of origin, were conducted to assess whether these factors had any influence on the effect of the intervention. Data were analyzed as intention to treat. RESULTS A total of 10 360 immigrant women, 5227 (50.4%; mean [SD] age, 44.0 [12.0] years) in the intervention group and 5133 (49.6%; mean [SD] age, 44.5 [11.6] years) in the control group, belonging to 39 general practices in the intervention area and 34 in the control area, were included in the study. The proportion of immigrant women screened increased by 2.6% in the intervention group and 0.6% in the control group. After adjustment for screening status at baseline, women in the intervention group were more likely to have participated in CCS (OR, 1.24 [95% CI, 1.11-1.38]). This statistically significant effect remained unchanged after adjustment for women's characteristics (OR, 1.24 [95% CI, 1.11-1.38]) and was reduced, but still significant, after further adjustment for GP characteristics (OR, 1.19 [95% CI, 1.06-1.34]). In subgroup analyses, the intervention particularly increased participation among women who were not previously screened at baseline (OR, 1.35 [95% CI, 1.16-1.56]), and those from Poland, Pakistan, and Somalia (OR, 1.74 [95% CI, 1.17-2.61]) when adjusting for baseline screening status. CONCLUSIONS AND RELEVANCE Our intervention targeting general practices significantly increased CCS participation among immigrants, although the absolute effect size of 2% in the fully adjusted model was small. Engaging other primary health professionals such as midwives to perform CCS could further contribute to increasing participation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03155581.
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Affiliation(s)
- Kathy Ainul Møen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Unit for Migration and Health, Norwegian Institute of Public Health (FHI), Oslo, Norway
| | - Bernadette Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health (FHI), Oslo, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Unit for Migration and Health, Norwegian Institute of Public Health (FHI), Oslo, Norway
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Brevik TB, Laake P, Bjørkly S. Effect of culturally tailored education on attendance at mammography and the Papanicolaou test. Health Serv Res 2020; 55:457-468. [PMID: 31994187 PMCID: PMC7240773 DOI: 10.1111/1475-6773.13271] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives To determine the effectiveness of culturally tailored education on attendance at breast and cervical cancer screening among ethnic minority women. Data Sources Systematic database searches in Ovid MEDLINE, ProQuest, PubMed, PsycINFO, and Cochrane CENTRAL. Study Design Randomized controlled trials (RCTs) of culturally tailored educational interventions to ethnic minority women in Western countries were investigated for a meta‐analysis. RCTs that assessed attendance at mammography or the Papanicolaou test (Pap test) were eligible for inclusion. Data Collection Methods Study characteristics and results were extracted separately. Independent raters assessed risk of bias by using Cochrane Collaboration's tool. Principal Findings Seven RCTs (n = 4246) were included in the meta‐analysis of mammography attendance, and four RCTs (n = 1750) were included in the meta‐analysis of Pap test attendance. The effect of culturally tailored educational interventions on attendance at mammography was an increase of 18 percent (RR = 1.18, 95% CI, 1.09‐1.28, P < .001), with low heterogeneity (I2 = 30.0, P = .237), and a 54 percent increase at the Pap test (RR = 1.54, 95% CI, 1.14‐2.09, P = .005), with substantial heterogeneity (I2 = 75.9%, P = .001). Conclusions Interpreted within the limitations set by the low number of studies and substantial heterogeneity for the Pap test, findings from the current meta‐analyses indicate that culturally tailored educational interventions may increase attendance of ethnic minority women at breast and cervical cancer screenings. There is a need for more studies, in particular RCTs conducted outside the United States, to determine if such findings are similar in other countries.
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Affiliation(s)
- Thea Beate Brevik
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway.,Clinic of Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - Petter Laake
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway.,Oslo Centre for Statistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Stål Bjørkly
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway.,Centre for Forensic Research, Oslo University Hospital, Oslo, Norway
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Brzoska P, Aksakal T, Yilmaz-Aslan Y. Utilization of cervical cancer screening among migrants and non-migrants in Germany: results from a large-scale population survey. BMC Public Health 2020; 20:5. [PMID: 31906964 PMCID: PMC6945536 DOI: 10.1186/s12889-019-8006-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/27/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Studies from European and non-European countries have shown that migrants utilize cervical cancer screening less often than non-migrants. Findings from Germany are inconsistent. This can be explained by several limitations of existing investigations, comprising residual confounding and data which is restricted to only some regions of the country. Using data from a large-scale and nationwide population survey and applying the Andersen Model of Health Services Use as the theoretical framework, the aim of the present study was to examine the role that different predisposing, enabling and need factors have for the participation of migrant and non-migrant women in cervical cancer screening in Germany. METHODS We used data from the 'German Health Update 2014/2015' survey on n = 12,064 women ≥20 years of age. The outcome of interest was the participation in cancer screening (at least once in lifetime vs. no participation). The outcome was compared between the three population groups of non-migrants, migrants from EU countries and migrants from non-EU countries. We employed multivariable logistic regression to examine the role of predisposing, enabling and need factors. RESULTS Non-EU and EU migrant women reported a lower utilization of cervical cancer screening (50.1 and 52.7%, respectively) than non-migrant women (57.2%). The differences also remained evident after adjustment for predisposing, enabling and need factors. The respective adjusted odds ratios (OR) for non-EU and EU migrants were OR = 0.67 (95%-CI = 0.55-0.81) and OR = 0.80 (95%-CI = 0.66-0.97), respectively. Differences between migrants and non-migrants were particularly pronounced for younger age groups. Self-rated health was associated with participation in screening only in non-migrants, with a poorer health being indicative of a low participation in cancer screening. CONCLUSIONS The disparities identified are in line with findings from studies conducted in other countries and are indicative of different obstacles this population group encounters in the health system. Implementing patient-oriented health care through diversity-sensitive health services is necessary to support informed decision-making.
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Affiliation(s)
- Patrick Brzoska
- Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Tuğba Aksakal
- Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- Bielefeld University, School of Public Health, Department of Epidemiology & International Public Health, 33501 Bielefeld, Germany
| | - Yüce Yilmaz-Aslan
- Bielefeld University, School of Public Health, Department of Epidemiology & International Public Health, 33501 Bielefeld, Germany
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McComb E, Ramsden V, Olatunbosun O, Williams-Roberts H. Knowledge, Attitudes and Barriers to Human Papillomavirus (HPV) Vaccine Uptake Among an Immigrant and Refugee Catch-Up Group in a Western Canadian Province. J Immigr Minor Health 2019; 20:1424-1428. [PMID: 29445898 DOI: 10.1007/s10903-018-0709-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vaccination is a key strategy to prevent cervical cancer in developed countries. Lower uptake of human papillomavirus (HPV) vaccine among new immigrants and refugees has been documented, although exploration of underlying reasons remains an understudied area. Semi-structured interviews with eleven immigrant women (ages 18-26 years) were conducted to understand their knowledge, attitudes and barriers regarding HPV vaccination in a western Canadian province. Participants had limited knowledge about HPV and the vaccine. Most women perceived that their risk of HPV was low, however expressed willingness to receive the vaccine if it were recommended by their physician. Greater efforts are needed to increase knowledge about HPV among immigrant and refugee women and support for physicians to discuss and offer vaccination to this underserved population.
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Affiliation(s)
- Erin McComb
- Department of Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, University of Saskatchewan, 107 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
| | - Vivian Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Olufemi Olatunbosun
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Saskatoon, SK, Canada
| | - Hazel Williams-Roberts
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
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Bucchi L, Baldacchini F, Mancini S, Ravaioli A, Giuliani O, Vattiato R, Falcini F, Giorgi Rossi P, Campari C, Canuti D, Di Felice E, Sassoli de Bianchi P, Ferretti S, Bertozzi N, Biggeri A. Estimating the impact of an organised screening programme on cervical cancer incidence: A 26-year study from northern Italy. Int J Cancer 2018; 144:1017-1026. [PMID: 30120770 DOI: 10.1002/ijc.31806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 11/09/2022]
Abstract
The impact of the organised cervical cancer (CC) screening programmes implemented in Europe since the 1990s has been insufficiently evaluated. We investigated the changes in CC incidence following the introduction of a screening programme in the Emilia-Romagna Region (northern Italy). The study period was 1988-2013. The programme, targeting women aged 25-64 years (1,219,000 in 2018), started in 1998. The annual incidence rates that would be expected in 1998-2013 in the absence of screening were estimated, first, by analysing the annual rates in 1988-1997 with a log-linear model and, second, by analysing the annual rates in 1988-2013 with an age-period model in which the period effect was enforced to be linear. Cervical adenocarcinoma incidence trend over the entire period was used to validate both estimates. Observed annual rates were compared to the two series of expected ones with the incidence rate ratio (IRR). Incidence remained stable during 1988-1997, peaked in 1998 and then decreased until 2007, when it stabilised. The two series of expected rates were virtually coincident and their trends roughly paralleled the stable adenocarcinoma incidence trend. After 2007, the median IRR was 0.60 (95% confidence interval, 0.45-0.81) based on the log-linear model and 0.58 (95% confidence interval, 0.34-0.97) based on the age-period model. Thirty-six to seventy-five CC cases were prevented annually for an average annual frequency of 6.5 per 100,000 women in the target population. In summary, consistent circumstantial evidences were obtained that the organised screening programme brought about a 40% reduction in annual CC incidence after 10 years.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy.,Cancer Prevention Unit, Local Health Authority, Forlì, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Local Health Authority and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Cinzia Campari
- Cancer Screening Unit, Local Health Authority and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Debora Canuti
- Cancer Screening Unit, Local Health Authority, Rimini, Italy
| | - Enza Di Felice
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | | | - Stefano Ferretti
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Nicoletta Bertozzi
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Annibale Biggeri
- Department of Statistics, Computer Science, and Applications "G. Parenti", University of Florence, Florence, Italy
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Differences in cervical cancer screening between immigrants and nonimmigrants in Norway: a primary healthcare register-based study. Eur J Cancer Prev 2018; 26:521-527. [PMID: 27749381 PMCID: PMC5627531 DOI: 10.1097/cej.0000000000000311] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Supplemental Digital Content is available in the text. The prevalence of cervical cancer is high among some groups of immigrants. Although there is evidence of low participation in cervical cancer screening programs among immigrants, studies have been subject to selection bias and accounted for few immigrant groups. The aim of this study was to compare the proportion of several groups of immigrants versus nonimmigrants attending the cervical cancer-screening program in Norway. In addition, we aimed to study predictors for attendance to the screening program. Register-based study using merged data from four national registries. All Norwegian-born women (1 168 832) and immigrant women (152 800) of screening age for cervical cancer (25–69 years) registered in Norway in 2008 were included. We grouped the immigrants by world’s geographic region and carried out descriptive analyses and constructed several logistic regression models. The main outcome variable was whether the woman was registered with a Pap smear in 2008 or not. Immigrants had lower rates of participation compared with Norwegian-born women; Western Europe [adjusted odds ratio (OR), 95% confidence interval (CI): 0.84, 0.81–0.88], Eastern Europe (OR 0.64, 95% CI: 0.60–0.67), Asia (OR 0.74, 95% CI: 0.71–0.77), Africa (OR 0.61, 95% CI: 0.56–0.67) and South America (OR 0.87, 95% CI: 0.79–0.96). Younger age, higher income, residence in rural areas, and having a female general practitioner (GP) were associated with Pap smear. Longer residential time in Norway and having a nonimmigrant GP were associated with screening for some immigrant groups. Appropriate interventions targeting both immigrants and GPs need to be developed and evaluated.
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Idehen EE, Koponen P, Härkänen T, Kangasniemi M, Pietilä AM, Korhonen T. Disparities in cervical screening participation: a comparison of Russian, Somali and Kurdish immigrants with the general Finnish population. Int J Equity Health 2018; 17:56. [PMID: 29728104 PMCID: PMC5935973 DOI: 10.1186/s12939-018-0768-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is currently ranked as the fourth commonly diagnosed cancer in women globally. A higher incidence has been reported in low- and-middle-income countries, and the disease poses significant public health challenges. Evidence suggests that this disease is preventable by means of regular screening using the Papanicolaou (Pap) test. However, limited knowledge exists about disparities in cervical screening participation among immigrants compared with non-immigrants, in countries with universal cervical screening programmes. We aimed to examine disparities in cervical screening participation among women of Russian, Somali, and Kurdish, origin in Finland, comparing them with the general Finnish population (Finns). We controlled for differences in several socio-demographic and health-related variables as potential confounders. Methods We employed data from the Finnish Migrant Health and Well-being Study 2010–2012 and the National Health 2011 Survey. Data collection involved face-to-face interviews. Data on screening participation in the previous five years from women aged 29–60 were available from 537 immigrants (257 Russians, 113 Somalis, 167 Kurds) and from 436 Finns. For statistical analyses, we used multiple logistic regression. Results Age-adjusted screening participation rates were as follows: Russians 79% (95% CI 72.9–84.4), Somalis 41% (95% CI 31.4–50.1), and Kurds 64% (95% CI 57.2–70.8), compared with 94% (95% CI 91.4–95.9) among Finns. After additionally adjusting for socio-demographic and health-related confounders, all the immigrant groups showed a significantly lower likelihood of screening participation when compared with Finns. The Odds Ratios were as follows: Russians 0.32 (95% CI 0.18–0.58), Somalis 0.10 (95% CI 0.04–0.23), and Kurds 0.17 (95% CI 0.09–0.35). However, when additionally accounting for country of origin-confounder interactions, such differences were attenuated. Conclusions Our results indicate disparities in screening participation among these immigrants and a lower likelihood of screening participation compared with the general Finnish population. To improve equity in cervical cancer screening participation, appropriate culturally tailored intervention programmes for each immigrant group might be beneficial.
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Affiliation(s)
- Esther E Idehen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 70211, Kuopio, Finland.
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tellervo Korhonen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 70211, Kuopio, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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