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Rajkhowa P, Mathew M, Fadra R, Saha S, Rakshitha K, Narayanan P, Brand H. A scoping review of evidence on routine cervical cancer screening in South Asia: investigating factors affecting adoption and implementation. Cancer Causes Control 2024:10.1007/s10552-024-01923-y. [PMID: 39375278 DOI: 10.1007/s10552-024-01923-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/27/2024] [Indexed: 10/09/2024]
Abstract
NEED: Cervical cancer is a major global public health issue, particularly affecting low and middle-income countries, distinctly in the South Asian region. This geographical region lacks a well-organized routine cervical screening program. Consequently, this scoping review aimed to investigate the evidence on factors influencing the adoption and implementation of routine cervical cancer screening in South Asia. METHODS Adopting the "Arksey and O'Malley and Levac et al." methodology, databases such as PubMed, CINAHL, Web of Science, and Scopus were scrutinized in the pursuit of relevant studies. Subsequently, the collected data were synthesized by adopting the Consolidated Framework for Implementation Research (CFIR) model. RESULTS A total of 837 records were initially identified and screened for eligibility, including 55 studies. The successful adoption and implementation of cervical cancer screening in South Asia encounter numerous obstacles within the health system, including the absence of a comprehensive program protocol for screening, inadequate health infrastructure, and the presence of multiple sociocultural factors, such as social stigma, low levels of education, and concerns related to modesty. CONCLUSION To optimize adoption and implementation, it is imperative to construct a customized policy framework that incorporates a risk communication strategy tailored to the specific contexts of these nations. Drawing insights from the experiences of South Asian countries in executing cervical cancer screening programs can inform the formulation of policies for similar healthcare initiatives aimed at facilitating the expansion of HPV vaccination efforts.
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Affiliation(s)
- Priyobrat Rajkhowa
- Department of Health Policy, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education (MAHE), Manipal, 576104, Karnataka, India
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mebin Mathew
- Department of Health Policy, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education (MAHE), Manipal, 576104, Karnataka, India
| | - Razeena Fadra
- Department of Health Policy, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education (MAHE), Manipal, 576104, Karnataka, India
| | - Soumyajit Saha
- Department of Health Policy, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education (MAHE), Manipal, 576104, Karnataka, India
| | - K Rakshitha
- Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Prakash Narayanan
- Department of Health Policy, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education (MAHE), Manipal, 576104, Karnataka, India
| | - Helmut Brand
- Department of Health Policy, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education (MAHE), Manipal, 576104, Karnataka, India.
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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Chemineau M, Odelin N, Reitz L, Bertolotti A, Balaya V, Boukerrou M, Tran PL. [How do women in Réunion Island want to perform HPV test on vaginal sampling as part of cervical cancer screening?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00296-4. [PMID: 39332630 DOI: 10.1016/j.gofs.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 09/17/2024] [Accepted: 09/18/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Since the introduction of HPV testing as a first-line screening method for women aged 30 and over, vaginal sampling (VS) by a healthcare professional or self-sampling (SS) is now possible for women who have not responded to the organized screening program using cervical uterine sampling. The aim of this study was to understand the choices made by a sample of women from La Reunion would like to perform their VS, and the content of the instructions they would like to receive. METHODS We conducted a cross-sectional descriptive study using a single-answer questionnaire. Patients were either interviewed in doctors' office or offered the possibility to answer an online questionnaire. We included women aged 30 to 65 in La Reunion who were concerned by CC screening. We compared the answers of women who were up to date with their screening with those of women who were not. RESULTS We included 202 women. The study showed that 64.9% of patients wished to collect the VS kit from a healthcare professional, 80.8% wished to perform SS and 52.5% wished to return it to the laboratory. The preferred language of the instruction was French, with pictures and drawings for 48.5% of patients. There was no significant difference between the answers of women who were up to date with their screening and those who were not. CONCLUSION In a sample of women eligible for CC screening in La Reunion, the preferred methods for CC screening were to collect the PV kit from a healthcare professional, perform the SS at home and then return it to the laboratory. These responses differed from other studies. A feasibility study on a part of La Reunion's eligible population for CC screening would enable us to assess the feasibility and generalizability of a screening modality based on SS.
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Affiliation(s)
- Marilou Chemineau
- UFR santé, université de la Réunion, 40, avenue de Soweto, Terre-Sainte, BP 373, 97455 Saint-Pierre cedex, Réunion
| | - Natacha Odelin
- Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion
| | - Laurianne Reitz
- Service de gynécologie-obstétrique, centre hospitalier universitaire Nord Réunion, Allée des topazes, 97400 Saint-Denis, Réunion
| | - Antoine Bertolotti
- Service de dermatologie et maladies infectieuses, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion; Inserm, CIC 1410, Reunion University Hospital, 97448 Saint-Pierre, Réunion
| | - Vincent Balaya
- Service de gynécologie-obstétrique, centre hospitalier universitaire Nord Réunion, Allée des topazes, 97400 Saint-Denis, Réunion
| | - Malik Boukerrou
- UFR santé, université de la Réunion, 40, avenue de Soweto, Terre-Sainte, BP 373, 97455 Saint-Pierre cedex, Réunion; Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion; Centre d'études périnatales de l'océan indien (UR 7388), université de la Réunion, Saint-Pierre, France
| | - Phuong Lien Tran
- UFR santé, université de la Réunion, 40, avenue de Soweto, Terre-Sainte, BP 373, 97455 Saint-Pierre cedex, Réunion; Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion; Inserm, CIC 1410, Reunion University Hospital, 97448 Saint-Pierre, Réunion.
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Hansen BT, Nygård M, Castle PE, Burger EA, Aasbø G. Sociodemographic characteristics associated with cervical cancer screening participation by send-to-all and opt-in HPV self-sampling: Who benefits? Results from a randomized controlled trial among long-term non-attending women in Norway. Int J Cancer 2024; 155:1053-1067. [PMID: 38751040 DOI: 10.1002/ijc.34989] [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: 11/14/2023] [Revised: 03/11/2024] [Accepted: 04/12/2024] [Indexed: 07/16/2024]
Abstract
With the objective to investigate associations between sociodemographic characteristics and participation in interventions designed to increase participation in cervical cancer screening among under-screened women, we randomized a random sample of 6000 women in Norway aged 35-69 years who had not attended cervical screening for ≥10 years to receive either (i) a reminder to attend regular screening (control), (ii) an offer to order a self-sampling kit (opt-in), or (iii) a self-sampling kit unsolicited (send-to-all). We analyzed how sociodemographic characteristics were associated with screening participation within and between screening arms. In the send-to-all arm, increased screening participation ranged from 17.1% (95% confidence interval [95% CI] = 10.3% to 23.8%) to 30.0% (95% CI = 21.5% to 38.6%) between sociodemographic groups. In the opt-in arm, we observed smaller, and at times, non-significant increases within the range 0.7% (95% CI = -5.8% to 7.3%) to 19.1% (95% CI = 11.6% to 26.7%). In send-to-all versus control comparisons, there was greater increase in participation for women in the workforce versus not (6.1%, 95% CI = 1.6% to 10.6%), with higher versus lower income (7.6%, 95% CI = 2.2% to 13.1%), and with university versus primary education (8.5%, 95% CI = 2.4% to 14.6%). In opt-in versus control comparisons, there was greater increase in participation for women in the workforce versus not (4.6%, 95% CI = 0.7% to 8.5%), with higher versus lower income (6.3%, 95% CI = 1.5% to 11.1%), but lower increase for Eastern European versus Norwegian background (-12.7%, 95% CI = -19.7% to -5.7%). Self-sampling increased cervical screening participation across all sociodemographic levels, but inequalities in participation should be considered when introducing self-sampling, especially with the goal to reach long-term non-attending women.
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Affiliation(s)
- Bo T Hansen
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Phil E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gunvor Aasbø
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Interdisciplinary Health Science, University of Oslo, Oslo, Norway
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Baddou R, Yacouti A, Guennouni M, Got AE, Benider A, Mouallif M. Study of Knowledge, Attitudes, Acceptability and Preference of Home-based HPV Self-Sampling Among a Population of Moroccan Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02503-z. [PMID: 39254894 DOI: 10.1007/s13187-024-02503-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 09/11/2024]
Abstract
In Morocco, cervical cancer screening rate is still low, which determines the need to adopt new screening approaches. Vaginal self-sampling for HPV testing is one of these strategies. Anticipating changes in screening plans for CC, we would like to present to health authorities a global view about the acceptability and preference of vaginal self-sampling for HPV testing among a population of Moroccan women. The aim of this pilot study is to assess the acceptability and preference of vaginal self-sampling for HPV testing among a population of Moroccan women. A cross-sectional study surveyed 400 Moroccan women aged between 25 and 65 years, who are recruited from various healthcare facilities in three Moroccan regions, between March and November 2022. Data were collected via interviews, using a questionnaire. Among the 400 participants, 380 (95%) were ready to undergo a vaginal self-sampling for HPV testing. Among participants who expressed their willingness to perform this test, 295 (73.6%) prefer to carry out it at home. A decreased likelihood of HPV self-sampling was determined by belief that only women with vaginal discharge or bleeding need to be screened. Age, marital status, perceived severity of CC, practice CC screening, and perceived self-efficacy were identified as the main factors influencing the preference for home based vaginal self-sampling for HPV testing. Vaginal self-sampling for HPV testing is an alternative option that could overcome a set of screening barriers defined in the Moroccan context, in order to increase CC screening coverage.
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Affiliation(s)
- R Baddou
- Laboratory of Health Sciences and Technologies, Epidemiology and Biomedical Unit, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - A Yacouti
- Laboratory of Health Sciences and Technologies, Epidemiology and Biomedical Unit, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - M Guennouni
- Laboratory of Health Sciences and Technologies, Epidemiology and Biomedical Unit, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
- Higher School of Education and Training, Chouaîb Doukkali University of El Jadida, El Jadida, Morocco
| | - A El Got
- Laboratory of Health Sciences and Technologies, Epidemiology and Biomedical Unit, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - A Benider
- Mohammed VI Center for the Treatment of Cancers, Ibn Rochd University Hospital Center Casablanca, Casablanca, Morocco
| | - M Mouallif
- Laboratory of Health Sciences and Technologies, Epidemiology and Biomedical Unit, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco.
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Danan ER, Amundson EC, Gowdy-Jaehnig A, Friedman JK, Pratt R, Krebs EE, Spoont M, Ackland PE. "It Feels Like Health Care with the Patient in Mind": VA Patient and Staff Perspectives on Self-Collected HPV Testing. Womens Health Issues 2024; 34:518-527. [PMID: 38890078 DOI: 10.1016/j.whi.2024.05.003] [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: 01/22/2024] [Revised: 04/21/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Self-collected testing for human papillomavirus (HPV) is poised to transform cervical cancer screening. Self-tests demonstrate similar accuracy to clinician-collected tests, but for the half a million women served by the Veterans Health Administration (VA) and their clinicians, self-collected cervical cancer screening would be a new practice. We examined VA patient and staff perspectives to inform future implementation. METHODS Semi-structured telephone interviews were conducted between 2021 and 2022 with female veterans receiving VA care (n = 22) and VA women's health nurses, clinicians, and administrators (n = 27). Interviews were audio-recorded and transcribed. Interview questions addressed knowledge and interest, potential advantages or disadvantages, and any questions participants had about self-collected screening. Responses were analyzed using rapid qualitative methods. MAIN FINDINGS Five overarching themes were identified. Both patients and staff indicated high interest and enthusiasm for self-collected HPV testing, tempered by questions about test accuracy and logistical considerations. Familiarity with self-testing for other conditions such as colon-cancer screening or COVID made self-collection seem like a simple, convenient option. However, self-testing was not viewed as a good fit for all patients, and concerns about lost opportunities or missed incidental lesions were raised. Patients and staff described challenges with pelvic examinations for patients with past sexual trauma, particularly in the male-dominated VA environment. Pelvic exams can leave patients feeling vulnerable and exposed; self-collected testing was seen as a mechanism for patient empowerment. PRINCIPAL CONCLUSIONS Veteran patients and VA staff shared common perspectives about potential advantages and disadvantages of self-collected HPV testing. Self-collected HPV testing has the potential to improve trauma-informed preventive health care for veterans.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Erin C Amundson
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Alexandra Gowdy-Jaehnig
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Jessica K Friedman
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Greater Los Angeles VA Health Care System, Los Angeles, California
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Erin E Krebs
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Michele Spoont
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Princess E Ackland
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Fontenot HB, Fuzzell L, Brownstein NC, Lake P, Michel A, Vadaparampil ST, Perkins RB. Health Care Provider Willingness to Recommend Self-collected Tests for Human Papillomavirus: A Mixed Methods Examination of Associated Factors. Womens Health Issues 2024; 34:506-517. [PMID: 38960815 DOI: 10.1016/j.whi.2024.05.005] [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: 01/11/2024] [Revised: 05/03/2024] [Accepted: 05/24/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Cervical cancer disproportionately affects those who are underscreened. Human papillomavirus self-collection is a promising tool to expand screening. OBJECTIVE Study objectives were to examine 1) factors (provider characteristics and practice type) associated with and 2) attitudes (perceived benefits and concerns) toward using human papillomavirus self-collection for cervical cancer screening in clinical practice. METHODS This study had a mixed method design; prior to regulatory approval of self-collection, we conducted a national survey and interviews of health care providers who perform cervical cancer screening. Quantitative measures included provider and practice characteristics, willingness to recommend, and preferences related to self-collection. Qualitative interviews further elucidated provider perspectives. RESULTS A total of 1,251 providers completed surveys, and 56 completed interviews. Among survey respondents, 33.4% reported they were likely to offer self-collection, 28.6% were unsure, and 38.0% reported they were unlikely. Most would offer self-collection either in the clinic or at home per patient preference. Male participants, advanced practice providers, internal and family physicians, and those practicing in academic medical center, hospital, or community health settings were more likely than female participants, obstetrician-gynecologist physicians, and those in private practice to indicate they were likely to offer self-collection. Concerns expressed in both surveys and interviews included the adequacy of sample collection and the ability to follow up. Respondents felt that self-collection would be particularly beneficial for those who did not have access to clinician-collected screening, as well as for patients who may have difficulty with pelvic examinations for any reason. CONCLUSION Providers considered human papillomavirus self-collection to be a way to expand access for patients with health care barriers and pelvic examination difficulties. They had concerns related to sample adequacy and follow-up after abnormal results.
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Affiliation(s)
- Holly B Fontenot
- University of Hawaii at Manoa, School of Nursing, Honolulu, Hawaii.
| | - Lindsay Fuzzell
- H. Lee Moffitt Cancer Center & Research Institute, Department of Health Outcomes and Behavior, Tampa, Florida
| | - Naomi C Brownstein
- Medical University of South Carolina, Public Health Sciences, Charleston, South Carolina
| | - Paige Lake
- H. Lee Moffitt Cancer Center & Research Institute, Department of Health Outcomes and Behavior, Tampa, Florida
| | - Alexandra Michel
- Rosalind Franklin University College of Nursing, North Chicago, Illinois
| | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, Department of Health Outcomes and Behavior, Tampa, Florida
| | - Rebecca B Perkins
- Boston University, Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, Massachusetts
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Mackay O, Lifford KJ, Kalra A, Williams D. Identifying optimum implementation for human papillomavirus self-sampling in underserved communities: A systematic review. J Med Screen 2024:9691413241274312. [PMID: 39212004 DOI: 10.1177/09691413241274312] [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: 09/04/2024]
Abstract
OBJECTIVE To review the existing evidence to identify the optimum methods for implementing human papillomavirus self-sampling to increase screening uptake for underserved groups. SETTING Specific groups are less likely to participate in cervical screening. These include individuals from low socioeconomic status groups, ethnic minority groups, younger age groups (25-29), older age groups (≥50), with a physical disability, with a learning disability and with an LGBTQ+ identity. The advent of human papillomavirus self-sampling for cervical screening presents an opportunity to promote equitable access to screening. Implementation for human papillomavirus self-sampling can vary, for example, opt-out or opt-in approaches. However, it is unclear which of these is the best method of offering human papillomavirus self-sampling to underserved groups. METHODS Six databases were searched through May 2023. Studies comparing cervico-vaginal human papillomavirus self-sampling provision using different implementation strategies with the standard screening pathway in underserved groups were identified. A narrative synthesis was conducted. RESULTS In total, 4574 studies were identified; 25 studies were included, of which 22 were from high-income countries. Greater uptake was found for offering human papillomavirus self-sampling compared to standard clinician-based sampling. Directly mailing human papillomavirus self-sampling kits to participants resulted in higher uptake of screening than using an 'opt-in' approach or standard recall in low socioeconomic status and ethnic minority groups, and older women. Strategies that used community health workers or educational materials increased uptake in ethnic minority and low socioeconomic status groups. CONCLUSIONS Directly mailing human papillomavirus self-sampling kits to low socioeconomic status groups, ethnic minority groups and older women has the potential to increase uptake of human papillomavirus self-sampling. Using community health workers to offer human papillomavirus self-sampling should be considered for ethnic minority and low socioeconomic status groups. Further research exploring the preferences of younger women is needed.
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Affiliation(s)
| | | | - Anahat Kalra
- School of Medicine, Cardiff University, Cardiff, UK
| | - Denitza Williams
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Castle PE. Looking Back, Moving Forward: Challenges and Opportunities for Global Cervical Cancer Prevention and Control. Viruses 2024; 16:1357. [PMID: 39339834 PMCID: PMC11435674 DOI: 10.3390/v16091357] [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: 08/05/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/30/2024] Open
Abstract
Despite the introduction of Pap testing for screening to prevent cervical cancer in the mid-20th century, cervical cancer remains a common cause of cancer-related mortality and morbidity globally. This is primarily due to differences in access to screening and care between low-income and high-income resource settings, resulting in cervical cancer being one of the cancers with the greatest health disparity. The discovery of human papillomavirus (HPV) as the near-obligate viral cause of cervical cancer can revolutionize how it can be prevented: HPV vaccination against infection for prophylaxis and HPV testing-based screening for the detection and treatment of cervical pre-cancers for interception. As a result of this progress, the World Health Organization has championed the elimination of cervical cancer as a global health problem. However, unless research, investments, and actions are taken to ensure equitable global access to these highly effective preventive interventions, there is a real threat to exacerbating the current health inequities in cervical cancer. In this review, the progress to date and the challenges and opportunities for fulfilling the potential of HPV-targeted prevention for global cervical cancer control are discussed.
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Affiliation(s)
- Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, US National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr., Room 5E410, Rockville, MD 20850, USA
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Cora-Cruz MS, Martinez O, Perez S, Fang CY. Evaluating human papillomavirus (HPV) self-sampling among Latinas in the United States: A systematic review. Cancer Med 2024; 13:e70098. [PMID: 39148468 PMCID: PMC11327612 DOI: 10.1002/cam4.70098] [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: 01/12/2024] [Revised: 07/01/2024] [Accepted: 08/01/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Latinas experience the greatest cervical cancer incidence compared with other ethnic/racial groups in the United States (US) due in part to significant disparities in screening uptake. Social and structural conditions that impede access to and participation in screening include language barriers, concerns about documentation status, logistical issues (e.g., transportation, limited clinic hours), and cultural beliefs regarding modesty and promiscuity. To overcome these challenges, self-sampling for human papillomavirus (HPV) DNA testing has emerged as a potentially promising method for promoting cervical cancer screening among this population. Thus, this systematic review aimed to assess the acceptability of HPV self-sampling among US Latinas. METHODS Using EBSCOhost and PubMed databases, we searched for studies published in the past two decades (2003-2023) that described participation in HPV self-sampling among Latinas. Eleven articles met inclusion criteria. RESULTS The majority of studies were conducted in Florida, California, and Puerto Rico, were single-arm designs, and involved the use of community health workers and Spanish-language materials (e.g., brochures). Across studies, the majority of participants reported that self-sampling was acceptable with respect to ease of use, comfort (lack of pain), privacy, and convenience; however, some women were concerned about the accuracy of self-sampling or whether they had performed sample collection correctly. CONCLUSION Given the high acceptability, self-collection of cervicovaginal samples for HPV testing may offer a feasible option for enhancing participation in cervical cancer screening in this population that encounters significant barriers to screening.
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Affiliation(s)
- Marisol S Cora-Cruz
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Omar Martinez
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Sophia Perez
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Carolyn Y Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Drysdale H, Marlow LAV, Lim A, Waller J. Experiences of Self-Sampling and Future Screening Preferences in Non-Attenders Who Returned an HPV Vaginal Self-Sample in the YouScreen Study: Findings From a Cross-Sectional Questionnaire. Health Expect 2024; 27:e14118. [PMID: 38953514 PMCID: PMC11217896 DOI: 10.1111/hex.14118] [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: 01/24/2024] [Revised: 04/25/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND We assessed experiences of human papillomavirus (HPV) vaginal self-sampling and future screening preferences in an ethnically and socio-economically diverse group of women overdue for cervical screening. SETTING AND PARTICIPANTS A postal questionnaire was embedded in the YouScreen self-sampling trial in England: 32.5% (2712/8338) of kit completers returned the survey. Kit non-completers were encouraged to return a questionnaire, but no responses were received. Participants were ethnically diverse (40.3% came from ethnic minority backgrounds), and 59.1% came from the two most deprived quintiles. Differences in confidence in kit completion, trust in the test results and intention to attend a follow-up test if HPV-positive were evaluated using Pearson's χ2 analyses. Binary logistic regression models explored predictors of a future screening choice and preferences for urine versus vaginal self-sampling. RESULTS Most kit-completers reported high confidence in self-sampling (82.6%) and high trust in the results (79.9%), but experiences varied by ethnicity and screening status. Most free-text comments were positive but some reported difficulties using the device, pain or discomfort. Most women would opt for self-sampling in the future (71.3% vs. 10.4% for a clinician-taken test) and it was more often preferred by ethnic minority groups, overdue screeners and never attenders. Urine self-tests were preferred to vaginal tests (41.9% vs. 15.4%), especially among women from Asian, Black or Other Ethnic backgrounds. CONCLUSIONS Kit-completers were confident, found the test easy to complete, and trusted the self-sample results. However, experiences varied by ethnic group and some women highlighted difficulties with the kit. Most women would prefer self-sampling in the future, but it was not a universal preference, so offering a choice will be important. PATIENT OR PUBLIC CONTRIBUTION We did not have direct patient and public involvement and engagement (PPIE) in the questionnaire design. However, patients and public representatives did input into the design of the YouScreen trial and reviewed the wider study materials (e.g. participant information sheet). TRIAL REGISTRATION This questionnaire study was embedded in the YouScreen trial. The protocol for the YouScreen trial is available at https://www.isrctn.com/ISRCTN12759467. The National Institute for Health Research 43 Clinical Research Network (NIHR CRN) Central Portfolio Management System (CPMS) ID is 4441934.
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Affiliation(s)
- Hannah Drysdale
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
| | - Laura A V Marlow
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
- Centre for Cancer Prevention, Screening and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anita Lim
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
- Centre for Cancer Prevention, Screening and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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11
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Constantinou G, Ayers S, Mitchell EJ, Moore S, Jones AM, Downe S, Walker KF, Daniels J. The acceptability of group B streptococcal bacteria (GBS) testing to women, including self-swabbing procedures: A qualitative study. Midwifery 2024; 135:104063. [PMID: 38896943 DOI: 10.1016/j.midw.2024.104063] [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: 03/16/2023] [Revised: 02/16/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Group B streptococcus (GBS) is a bacterium carried by 20-25 % of pregnant women in the UK, which can be transmitted from pregnant women to their babies at the time of birth. Women can be tested for GBS in pregnancy using a vaginal-rectal swab, however, this testing is currently not routinely offered in the UK. A large clinical trial is underway to determine the clinical and cost-effectiveness of routine testing (ISRCTN reference number ISRCTN49639731). A crucial part of understanding whether this type of test should be implemented is women's views on the acceptability of being offered GBS tests, their preferences towards testing procedures and their willingness to receive these tests. AIM To explore women's views on the acceptability of different methods of Group B streptococcal bacteria (GBS) testing in pregnancy, including self-swabbing procedures. METHODS A convenience sample of 19 women (5 pregnant and 14 postpartum) were interviewed using a semi-structured interview guide. Interviews were transcribed and analysed using systematic thematic analysis. RESULTS Findings show that many of the women interviewed were not concerned about being offered a GBS test, were willing to provide a sample and felt positive towards samples being taken to detect GBS. Women varied in their preferences on the best time for sampling. Some thought being approached during pregnancy gave them time to understand the purpose of testing, prepare for what may happen next and ask questions about potential treatment if needed. Others thought labour was a good time to provide accurate results on GBS carriage at birth and reduce unnecessary worry during pregnancy. However, women were concerned that they may be unable to make an informed decision in labour due to time, pain and the prospect of birthing quickly. Women perceived clinician swabbing as more accurate than self-sampling; however, many thought clinician swabbing might be embarrassing so self-swabs should be available to increase uptake for some women. CONCLUSIONS Overall, women thought both pregnancy and labour were acceptable times to test for GBS. The majority found both clinician and self-swabbing procedures acceptable; however, many had a preferred swabbing option and thought women should be given the choice of the swabbing procedure most acceptable to them. It is important that women are given information about GBS testing and its procedures in pregnancy regardless of when the GBS swabbing is performed.
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Affiliation(s)
- Georgina Constantinou
- Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, Northampton Square EC1V 0HB, London.
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, Northampton Square EC1V 0HB, London
| | | | - Sarah Moore
- Nottingham Clinical Trials Unit, University of Nottingham, London
| | - Anne-Marie Jones
- Nottingham Clinical Trials Unit, University of Nottingham, London
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, London
| | - Kate F Walker
- Population and Lifespan Unit, School of Medicine, University of Nottingham, London
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, London
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12
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Garcia PJ, Santos C, Chiappe M, Valderrama M, Carcamo CP. Academic accountability to local communities and society through Programme Science: a case study from the HPV self-sampling programme HOPE in Peru. J Int AIDS Soc 2024; 27 Suppl 2:e26297. [PMID: 38988049 PMCID: PMC11236900 DOI: 10.1002/jia2.26297] [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: 10/10/2023] [Accepted: 05/15/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Health challenges in the 21st century underscore the need for adaptable and innovative approaches in public health. Academic institutions can and should contribute much more effectively to generate and translate scientific knowledge that will result in better programmes to improve societal health. Academic accountability to local communities and society requires universities to actively engage with local communities, understanding the context, their needs, and leveraging their knowledge and local experience. The Programme Science initiative provides a framework to optimize the scale, quality and impact of public health programmes, by integrating diverse approaches during the iterative cycle of research and practice within the strategic planning, programme implementation and programme management and evaluation. We illustrate how the Programme Science framework could be a useful tool for academic institutions to accomplish accountability to local communities and society through the experience of Project HOPE in Peru. DISCUSSION Project HOPE applied the Programme Science framework to introduce HPV self-sampling into a women's health programme in Peru. Collaboration with local authorities and community members was pivotal in all phases of the project, ensuring interventions aligned with community needs and addressing social determinants of health. The HOPE Ladies-community women trained and empowered to promote and provide the HPV kits-crafted the messages used through the study and developed strategies to reach individuals and provided support to women's journey through health centres. By engaging communities in co-creating knowledge and addressing health inequities, academic institutions can generate contextually relevant and socially just scientific knowledge. The active participation of community women in Project HOPE was instrumental in improving service utilization and addressing barriers to self-sampling. CONCLUSIONS The Programme Science approach offers a pathway for academic institutions to enhance their accountability to communities and society at large. By embedding researchers within public health programmes and prioritizing community engagement, academic institutions can ensure that research findings directly inform policy improvements and programmatic decisions. However, achieving this requires a realignment of research agendas and recognition of the value of community engagement. Establishing Programme Science networks involving academia, government and funding entities can further reinforce academic accountability and enhance the impact of public health programmes.
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Affiliation(s)
| | - Carlos Santos
- Directorate of Cancer Prevention and ControlMinistry of HealthLimaPeru
| | - Marina Chiappe
- School of Public HealthCayetano Heredia UniversityLimaPeru
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13
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Andrew-Bassey UI, Oke DO, Okunlola MA, Morhason-Bello IO. Scoping review protocol on the perception and attitude of women on methods for collecting cervicovaginal samples for human papillomavirus testing in sub-Saharan Africa. BMJ Open 2024; 14:e085408. [PMID: 38910004 PMCID: PMC11328614 DOI: 10.1136/bmjopen-2024-085408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION Sub-Saharan Africa (SSA) regions have the highest burden of cervical cancer (CC), accounting for nearly a quarter of global mortality. Many women in SSA are reluctant to access CC screening because they are uncomfortable exposing their private parts to healthcare providers. The perception of women who have experienced self-sampling in SSA is yet to be reviewed. This scoping review will explore the literature on the perception and attitude of women towards methods of collecting cervicovaginal samples for human papillomavirus (HPV) testing in SSA. METHODS AND ANALYSIS An extensive search using the Arksey and O'Malley framework will be conducted. The search criteria will be limited to original research conducted in community or clinical settings in SSA within the last 10 years. Four databases, namely, PUBMED, Cochrane, African Journals Online and Google Scholar, will be searched. Two independent persons (UIAB and DOO) will screen the titles and abstracts and later full texts using population, intervention, comparison and outcome criteria. IOMB will serve as a tiebreaker whenever there is no agreement on the choice of eligibility criteria. The screening process will be presented using Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review flow format. The descriptive analysis of eligible studies for scoping reviews will be summarised. We will describe themes of attitude and perception covering pain, embarrassment, privacy and comfortability, willingness to self-sample, anxiety and confidence. ETHICS AND DISSEMINATION This is a scoping review protocol and does not require ethical approval. Findings from this review will be disseminated through peer-reviewed publications, the production of policy briefs, and presentations at local and international conferences.
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Affiliation(s)
- Uduak Ima Andrew-Bassey
- Pan African University Life and Earth Sciences Institute (including Health and Agriculture), Ibadan, Oyo State, Nigeria
- Centre for Medical Informatics and Professional Development, Ibadan, Nigeria
| | - Deborah Olamiposi Oke
- Department of Epidemiology and Medical Statistics,College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- HPV Research Consortium, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Michael A Okunlola
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Imran O Morhason-Bello
- HPV Research Consortium, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, University of Ibadan College of Medicine, Ibadan, Nigeria
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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14
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Miazga W, Tatara T, Wnuk K, Gujski M, Pinkas J, Religioni U. The Impact of Urine-Sample HPV Testing on the Effectiveness of Screening for Cervical Cancer: An Umbrella Review. Cancers (Basel) 2024; 16:2244. [PMID: 38927949 PMCID: PMC11201501 DOI: 10.3390/cancers16122244] [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: 05/13/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The aim of the study was to evaluate the impact of urine-sample HPV (human papillomavirus) testing on the effectiveness of screening for cervical cancer. METHODS The analysis was based on the results of a systematic review. Secondary studies were searched in the following medical databases: Medline, Embase, and the Cochrane Library. The results of the statistical tests presented in the article originate from research conducted by the authors of the included articles. RESULTS From a total of 1869 citations, 5 studies were included in this review. Sensitivity and specificity for the detection of any HPV from first-void urine samples were 87% [95% CI: (0.74; 0.94)] and 89% [95% CI: (0.81; 0.93)], respectively. Moreover, participants in the analyzed studies had indicated that they felt comfortable with urine testing. CONCLUSIONS The development of methods to detect HPV infection in first-void urine samples and the application of this sampling method in widely available screening tests could significantly increase patients' willingness to participate in testing.
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Affiliation(s)
- Wojciech Miazga
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01-826 Warsaw, Poland; (W.M.)
| | - Tomasz Tatara
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Katarzyna Wnuk
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01-826 Warsaw, Poland; (W.M.)
| | - Mariusz Gujski
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01-826 Warsaw, Poland; (W.M.)
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01-826 Warsaw, Poland; (W.M.)
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15
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Song J, Ni YH, Fang J, Qu SX, Chen XY, Wu WL, Zhang WC, Qin JF. The levels of women's awareness, experience, acceptability and preference for Vaginal Human Papillomavirus (HPV) self-sampling in three provinces of China: a cross-sectional study. BMC Womens Health 2024; 24:343. [PMID: 38877469 PMCID: PMC11179292 DOI: 10.1186/s12905-024-03186-w] [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: 12/26/2023] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The primary screening technique for precancerous lesions and cervical cancer is human papillomavirus (HPV) testing, and HPV self-sampling has been shown to be consistent with clinician sampling in terms of the accuracy of the results and may improve cervical cancer screening rates. The aim of this study was to understand the level of awareness, experience, acceptability, and preference for vaginal HPV self-sampling among women in Jiangsu, Zhejiang, and Shanghai, China, and to analyze the possible influencing factors to determine the feasibility of implementing self-sampling. METHODS Overall, 1793 women were included in the data analysis. A self-administered questionnaire was utilized. In addition to descriptive analysis, univariate and multivariate analyses were used to explore the associations between sociodemographic features, history of cervical cancer screening, and the level of awareness, experience, acceptability, and preference for HPV self-samples. RESULTS The participants' level of awareness of and experience with HPV self-sampling were moderate. A total of 88.8% of participants rated the acceptability as "high", and self-sampling was preferred by 64.2% of them for cervical cancer screening. People aged 45 to 54 years showed a preference for both clinician sampling(OR = 1.762 (1.116-2.163)) and self-sampling (OR = 1.823 (1.233-2.697)). Those who had graduated from high school or above (OR = 2.305 (1.517-3.503), OR = 2.432 (1.570-3.768), OR = 3.258 (2.024-5.244)) preferred clinician-sampling, and those with a bachelor's degree or above (OR = 1.664 (1.042-2.657)) preferred self-sampling. Middle- and high-income individuals showed no preference for either sampling method (OR < 1). CONCLUSIONS HPV self-sampling is widely accepted, but awareness, experience and preferences need to be improved. These results may help to adjust public health strategies for the early inclusion of HPV self-sampling as a screening method in national initiatives to prevent cervical cancer.
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Affiliation(s)
- Jia Song
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Yi-Hua Ni
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Jing Fang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Shui-Xiang Qu
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Xiao-Yan Chen
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Wei-Li Wu
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Wei-Chu Zhang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Jian-Fen Qin
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China.
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16
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Doubova SV, McClellan SP, Martinez-Vega IP, Ureña-Bogarín EL, Martínez-Montañez OG. HPV Self-Sampling in the Workplace: A Qualitative Study of Benefits, Barriers, and Opportunities for Improvement Perceived by Health Professionals and Managers. Arch Med Res 2024; 55:103009. [PMID: 38823184 DOI: 10.1016/j.arcmed.2024.103009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 06/03/2024]
Abstract
AIM To inform the implementation of Human Papillomavirus Self-Sampling (HPV-SS) in the workplace, we assessed the perspectives of healthcare professionals and managers on the benefits, barriers, and opportunities for improvement of a pilot program. METHODS A qualitative descriptive study based on in-depth telephone interviews was conducted between June and August 2023. Data were analyzed through inductive thematic analysis. Fifteen health professionals from different companies and fifteen managers from the Mexican Institute of Social Security (IMSS) were interviewed. RESULTS Participants identified several benefits of the HPV-SS, including ease of use, privacy, convenience, affordability, reduced workplace absences, and promotion of a prevention culture. However, there were also individual and organizational barriers to program implementation. The former consisted of women's concerns about collecting a reliable sample or injuring themselves, lack of confidence in the HPV test, fear of positive results, and discomfort caused by the brush used to collect the sample. Organizational barriers included failure to follow up on positive test results, lack of knowledge of program indicators, perceived negative impact on the established Pap smear cervical cancer screening indicator, and the lack of government regulations supporting HPV testing. To improve the program, participants suggested disseminating information through mass media campaigns and social networks, providing companies with additional support from IMSS preventive staff, extending the work hours of IMSS Family Medicine clinics, and training IMSS health staff on the follow-up of women with HPV test results. CONCLUSIONS The study findings suggest potential areas for improvement in HPV-SS programs.
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Affiliation(s)
- Svetlana V Doubova
- Unidad de Investigación Epidemiológica y en Servicios de Salud Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Sean P McClellan
- Department of Family and Community Medicine, University of Illinois, Chicago, IL, USA
| | - Ingrid Patricia Martinez-Vega
- Unidad de Investigación Epidemiológica y en Servicios de Salud Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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17
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Le Goff J, Le Duc-Banaszuk AS, Lefeuvre C, Pivert A, Ducancelle A, De Pauw H, Arbyn M, Vinay A, Rexand-Galais F. Acceptance of Self-Sampling by Women Not Regularly Participating in Cervical Cancer Screening in Areas with Low Medical Density: A Qualitative Study within the French CapU4 Trial. Cancers (Basel) 2024; 16:2066. [PMID: 38893189 PMCID: PMC11171172 DOI: 10.3390/cancers16112066] [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: 05/07/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Cervical cancer (CC) was diagnosed in 3159 women in France in 2023, and 1117 died from it. Organized screening for cervical cancer is potentially very effective for participating women. However, reaching under-screened populations remains a major challenge. The present qualitative study explored women's opinions on what discourages or encourages them to participate in CC screening and assessed the acceptability of two experimental strategies (urinary or vaginal self-sampling kits) to increase the screening coverage in three rural French administrative departments with low medical density and/or low screening participation rates. Forty-eight semi-structured interviews and four focus groups were conducted by a team of psychologists. Results showed that the participants accepted at-home self-sampling to reach non-participating women in medically underserved areas. However, they suggested that the type of kit sent should be adapted to the patient's profile (embarrassment from earlier exams, cultural aspects, fear of invasiveness, etc.), and that kits should be simple to use (in understandable language taking sociocultural aspects into account). Women wished to be assured that testing on self-samples is accurate and needed information about further actions in case of a positive result.
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Affiliation(s)
- Johane Le Goff
- University of Angers, CLiPsy, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
| | - Anne-Sophie Le Duc-Banaszuk
- Pays de la Loire Regional Cancer Screening Coordination Center (CRCDC Pays de La Loire), F-49000 Angers, France;
| | - Caroline Lefeuvre
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Adeline Pivert
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Alexandra Ducancelle
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Hélène De Pauw
- Unit Cancer Epidemiology, Belgian Cancer Center, Sciensano, B1050 Brussels, Belgium; (H.D.P.); (M.A.)
| | - Marc Arbyn
- Unit Cancer Epidemiology, Belgian Cancer Center, Sciensano, B1050 Brussels, Belgium; (H.D.P.); (M.A.)
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, B9000 Ghent, Belgium
| | - Aubeline Vinay
- University of Angers, CLiPsy, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
| | - Franck Rexand-Galais
- University of Angers, CLiPsy, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
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Asensio-Puig L, de Andrés-Pablo Á, Khannous-Lleiffe O, Ibáñez R, Acera A, de Sanjosé S, Gabaldón T, Alemany L, Bruni L, Pavón MÀ. Proof of Concept Study: Comparability of Microbiome Diversity in Self- and Physician-Collected HPV-Positive and HPV-Negative Cervicovaginal Samples. Int J Mol Sci 2024; 25:5736. [PMID: 38891924 PMCID: PMC11172023 DOI: 10.3390/ijms25115736] [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: 04/23/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Recent studies have revealed the impact of human papillomavirus (HPV) infections on the cervicovaginal microbiome; however, few have explored the utility of self-collected specimens (SCS) for microbiome detection, obtained using standardised methods for HPV testing. Here, we present a proof-of-concept analysis utilising Oxford Nanopore sequencing of the 16S rRNA gene in paired samples collected either by the patient using an Evalyn Brush or collected by a physician using liquid-based cytology (LBC). We found no significant differences in the α-diversity estimates between the SCS and LBC samples. Similarly, when analysing β-diversity, we observed a close grouping of paired samples, indicating that both collection methods detected the same microbiome features. The identification of genera and Lactobacillus species in each sample allowed for their classification into community state types (CSTs). Notably, paired samples had the same CST, while HPV-positive and -negative samples belonged to distinct CSTs. As previously described in other studies, HPV-positive samples exhibited heightened bacterial diversity, reduced Lactobacillus abundance, and an increase in genera like Sneathia or Dialister. Altogether, this study showed comparable results between the SCS and LBC samples, underscoring the potential of self-sampling for analysing the microbiome composition in cervicovaginal samples initially collected for HPV testing in the context of cervical cancer screening.
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Affiliation(s)
- Laura Asensio-Puig
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (L.A.-P.); (Á.d.A.-P.); (R.I.); (L.A.); (L.B.)
- Programa de Doctorat en Biomedicina, Universitat de Barcelona (UB), 08036 Barcelona, Spain
| | - Álvaro de Andrés-Pablo
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (L.A.-P.); (Á.d.A.-P.); (R.I.); (L.A.); (L.B.)
- Programa de Doctorat en Biomedicina, Universitat de Barcelona (UB), 08036 Barcelona, Spain
| | - Olfat Khannous-Lleiffe
- Barcelona Supercomputing Centre (BSC-CNS), 08034 Barcelona, Spain; (O.K.-L.); (T.G.)
- Institute for Research in Biomedicine (IRB), 08028 Barcelona, Spain
| | - Raquel Ibáñez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (L.A.-P.); (Á.d.A.-P.); (R.I.); (L.A.); (L.B.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP CB06/02/0073), 28029 Madrid, Spain;
| | - Amelia Acera
- Atenció a la Salut Sexual i Reproductiva (ASSIR), SAP Cerdanyola-Ripollet, Institut Català de la Salut, 08291 Ripollet, Spain;
| | - Silvia de Sanjosé
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP CB06/02/0073), 28029 Madrid, Spain;
- ISGlobal, 08036 Barcelona, Spain
| | - Toni Gabaldón
- Barcelona Supercomputing Centre (BSC-CNS), 08034 Barcelona, Spain; (O.K.-L.); (T.G.)
- Institute for Research in Biomedicine (IRB), 08028 Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010 Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (L.A.-P.); (Á.d.A.-P.); (R.I.); (L.A.); (L.B.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP CB06/02/0073), 28029 Madrid, Spain;
| | - Laia Bruni
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (L.A.-P.); (Á.d.A.-P.); (R.I.); (L.A.); (L.B.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP CB06/02/0073), 28029 Madrid, Spain;
| | - Miquel Àngel Pavón
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (L.A.-P.); (Á.d.A.-P.); (R.I.); (L.A.); (L.B.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP CB06/02/0073), 28029 Madrid, Spain;
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Sukkasame P, Jareemit N, Punyashthira A, Inthasorn P, Chantawong N, Suwannarurk K, Pariyawateekul P, Tangjitgamol S. Attitude toward human papillomavirus self-sampling and associated factors among Thai women undergoing colposcopy. Obstet Gynecol Sci 2024; 67:286-295. [PMID: 38454573 PMCID: PMC11099094 DOI: 10.5468/ogs.23293] [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: 12/07/2023] [Revised: 12/07/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE To compare attitudes toward self-sampling for human papillomavirus (HPV) testing before and after specimen collection in women undergoing colposcopy. The factors associated with the pre-sampling attitude were also studied. METHODS This prospective study enrolled women with abnormal cervical cytology and/or positive high-risk HPV who attended colposcopy clinics at 10 cancer centers in Thailand between October 2021 and May 2022. Prior to colposcopy, the attitudes of the women toward self-sampling were surveyed through a questionnaire. Written and verbal instructions for self-sampling were provided before the process and subsequent colposcopy. The attitudes toward self-sampling were reassessed after the actual self-sampling. Factors associated with the attitudes were analyzed. RESULTS A total of 499 women were included in this study. The mean age was 39.28±11.36 years. A total of 85.3% were premenopause, and 98.8% had sexual experience. With the full score of 45, the attitude score after self-sampling was significantly higher than the attitude score before self-sampling (39.69±5.16 vs. 37.76±5.71; P<0.001). On univariate analysis, the factors associated with attitude before HPV self-sampling were age, menopausal status, sexual activity, education level, income, knowledge regarding HPV, and prior high-grade squamous intraepithelial lesion histology. The remaining significant factor on multivariate analysis was sexual activity within the past year (B=0.105, 95% confidence interval, 0.014-2.870; P=0.048). CONCLUSION Attitudes toward self-sampling improved after the actual self-sampling process, as evidenced by higher attitude scores. Sexual activity was the only independent factor related to the attitude before self-sampling.
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Affiliation(s)
- Pichamon Sukkasame
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Bangkok,
Thailand
| | - Nida Jareemit
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
| | - Awassada Punyashthira
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Thammasat University, Pathum Thani,
Thailand
| | - Perapong Inthasorn
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
| | - Nopwaree Chantawong
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Thammasat University, Pathum Thani,
Thailand
| | - Komsun Suwannarurk
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Thammasat University, Pathum Thani,
Thailand
| | - Piyawan Pariyawateekul
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Bangkok,
Thailand
| | - Siriwan Tangjitgamol
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok,
Thailand
- Department of Obstetrics and Gynecology, MedPark Hospital, Bangkok,
Thailand
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Dau H, Nankya E, Naguti P, Basemera M, Payne BA, Vidler M, Singer J, McNair A, AboMoslim M, Smith L, Orem J, Nakisige C, Ogilvie G. The economic burden of cervical cancer on women in Uganda: Findings from a cross-sectional study conducted at two public cervical cancer clinics. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002554. [PMID: 38489259 PMCID: PMC10942052 DOI: 10.1371/journal.pgph.0002554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
There is limited research on how a cervical cancer diagnosis financially impacts women and their families in Uganda. This analysis aimed to describe the economic impact of cervical cancer treatment, including how it differs by socio-economic status (SES) in Uganda. We conducted a cross-sectional study from September 19, 2022 to January 17, 2023. Women were recruited from the Uganda Cancer Institute and Jinja Regional Referral Hospital, and were eligible if they were ≥ of 18 years and being treated for cervical cancer. Participants completed a survey that included questions about their out-of-pocket costs, unpaid labor, and family's economic situation. A wealth index was constructed to determine their SES. Descriptive statistics were reported. Of the 338 participants, 183 were from the lower SES. Women from the lower SES were significantly more likely to be older, have ≤ primary school education, and have a more advanced stage of cervical cancer. Over 90% of participants in both groups reported paying out-of-pocket for cervical cancer. Only 15 participants stopped treatment because they could not afford it. Women of a lower SES were significantly more likely to report borrowing money (higher SES n = 47, 30.5%; lower SES n = 84, 46.4%; p-value = 0.004) and selling possessions (higher SES n = 47, 30.5%; lower SES n = 90, 49.7%; p-value = 0.006) to pay for care. Both SES groups reported a decrease in the amount of time that they spent caring for their children since their cervical cancer diagnosis (higher SES n = 34, 31.2%; lower SES n = 36, 29.8%). Regardless of their SES, women in Uganda incur out-of-pocket costs related to their cervical cancer treatment. However, there are inequities as women from the lower SES groups were more likely to borrow funds to afford treatment. Alternative payment models and further economic support could help alleviate the financial burden of cervical cancer care in Uganda.
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Affiliation(s)
- Hallie Dau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | | | | | - Miriam Basemera
- Cancer Unit, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Beth A. Payne
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Avery McNair
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Maryam AboMoslim
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Laurie Smith
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | | | | | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
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21
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Aimagambetova G, Atageldiyeva K, Marat A, Suleimenova A, Issa T, Raman S, Huang T, Ashimkhanova A, Aron S, Dongo A, Iztleuov Y, Shamkeeva S, Azizan A. Comparison of diagnostic accuracy and acceptability of self-sampling devices for human Papillomavirus detection: A systematic review. Prev Med Rep 2024; 38:102590. [PMID: 38283967 PMCID: PMC10821625 DOI: 10.1016/j.pmedr.2024.102590] [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: 09/06/2023] [Revised: 11/28/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Objective Cervical cancer screening coverage remains low in many countries worldwide. Self-sampling approach for cervical cancer screening has a good potential to improve the screening coverage. This study aims to compare different types of HPV self-sampling devices for cervical cancer screening to identify the most accurate and acceptable device(s). Methods A systematic review was performed on data extracted from all studies specific to HPV self-sampling devices by searching relevant articles in PubMed, Google Scholar, Scopus, Web of Science, ScienceDirect, Cochrane Library, and EBSCO published from 2013 to October 2023. The study was registered in PROSPERO (CRD42022375682). Results Overall, 70 papers met the eligibility criteria for this systematic review and were included in the analysis: 22 studies reported self-sampling devices diagnostic accuracy, 32 studies reported self-sampling devices acceptability and 16 studies reported both (accuracy and acceptability). The most popular self-sampling devices were Evalyn Brush, FLOQ Swab, Cervex-Brush, and Delphi Screener. Out of overall 38 studies analyzing self-sampling devices' diagnostic accuracy, 94.7% of studies reported that self-collected specimens provided sensitivity and specificity comparable with clinician-collected samples; acceptability of Evalyn Brush, FLOQ Swab, Delphi Screener, and Colli-Pee, varied between 84.2% and 100%. Conclusion The self-sampling approach has a good potential to increase cervical cancer screening coverage. Evalyn Brush, Cervex-Brush, FLOQ Swab, and Delphi Screener self-sampling devices for HPV detection were the most commonly utilized and found to be the most accurate, and patient-acceptable. HPV detection accuracy using these self-sampling devices had no significant difference compared to the sampling performed by healthcare providers.
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Affiliation(s)
- Gulzhanat Aimagambetova
- Department of Surgery, School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
| | - Kuralay Atageldiyeva
- Department of Medicine, School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
- Clinical Academic Department of Internal Medicine, CF “University Medical Center”, 10000 Astana, Kazakhstan
| | - Aizada Marat
- Department of Obstetrics and Gynecology #1, NJSC “Astana Medical University”, 010000, Astana, Kazakhstan
| | - Assem Suleimenova
- Kazakh National Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Torgyn Issa
- School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
| | - Sarina Raman
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Timothy Huang
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Ayimkul Ashimkhanova
- Department of Medicine, School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
- Department of Clinical Medicine, School of Medicine, Al Farabi University, Almaty, Kazakhstan
| | - Saida Aron
- School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
| | - Andrew Dongo
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Yerbolat Iztleuov
- Medical Center, Marat Ospanov West-Kazakhstan Medical University, 030000, Aktobe, Kazakhstan
| | - Saykal Shamkeeva
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University Hospital, 04103, Leipzig, Germany
| | - Azliyati Azizan
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
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22
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Nitkowski J, Giuliano AR, Ridolfi T, Chiao E, Fernandez ME, Schick V, Swartz MD, Smith JS, Nyitray AG. Acceptability of Anal Human Papillomavirus Home Self-Sampling and Clinician Sampling Among Sexual and Gender Minority Individuals in Milwaukee, Wisconsin: The Prevent Anal Cancer Self-Swab Study. LGBT Health 2024; 11:47-56. [PMID: 37870947 DOI: 10.1089/lgbt.2023.0012] [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: 10/25/2023] Open
Abstract
Purpose: Anal cancer has disproportionately high incidence among sexual minority men. We compared acceptability of home versus clinic human papillomavirus (HPV) anal swabbing. Methods: The Prevent Anal Cancer Self-Swab Study recruited sexual and gender minority individuals in Milwaukee, Wisconsin. Eligible participants were randomized to a home or clinic arm. Home participants received a mailed anal HPV self-sampling kit. Clinic participants attended a clinic appointment where a clinician collected an anal HPV swab. We examined acceptability (overall thoughts, comfort with method, pain, and future willingness to swab) of home versus clinic swabbing using postswab survey responses. Results: A total of 191 individuals completed swabbing and a postswab survey (home = 53.4%, clinic = 46.6%). Mean age was 47 years (range = 25-78). Reported overall thoughts about home (71.6%) and clinic (69.7%) swabbing were mostly positive (p = 0.83). Overall thoughts about the home kit did not differ by participant characteristics, but overall thoughts about clinician swabbing differed by race (p = 0.04) and HIV status (p = 0.002). Nearly all participants (98.4%) reported they were comfortable receiving the kit or getting the swabbing in the clinic, reported little or no pain (98.4%), and reported willingness to undergo swabbing in the future (97.9%). After swabbing, clinic participants reported greater trust that swabbing can give accurate information about anal cancer risk (89.9%) than home participants (69.6%) (p < 0.001), and that swabbing will help them avoid anal cancer (clinic = 79.8%, home = 59.8%) (p = 0.01). Conclusion: Anal swabbing acceptability was high and did not differ between home and clinic. Participants reported high confidence and knowledge using the mailed anal self-sampling kit. Clinical Trial Registration number is NCT03489707.
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Affiliation(s)
- Jenna Nitkowski
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tim Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elizabeth Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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23
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Fritzell K, Hedberg B, Woudstra A, Forsberg A, Sventelius M, Kottorp A, Jervaeus A. Making the BEST decision-the BESTa project development, implementation and evaluation of a digital Decision Aid in Swedish cancer screening programmes- a description of a research project. PLoS One 2023; 18:e0294332. [PMID: 38085710 PMCID: PMC10715660 DOI: 10.1371/journal.pone.0294332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Sweden has a long tradition of organized national population-based screening programmes. Participation rates differ between programmes and regions, being relatively high in some groups, but lower in others. To ensure an equity perspective on screening, it is desirable that individuals make an informed decision based on knowledge rather than ignorance, misconceptions, or fear. Decision Aids (DAs) are set to deliver information about different healthcare options and help individuals to visualize the values associated with each available option. DAs are not intended to guide individuals to choose one option over another. The advantage of an individual Decision Aid (iDA) is that individuals gain knowledge about cancer and screening by accessing one webpage with the possibility to communicate with health professionals and thereafter make their decision regarding participation. The objective is therefore to develop, implement and evaluate a digital iDA for individuals invited to cancer screening in Sweden. METHODS This study encompasses a process-, implementation-, and outcome evaluation. Multiple methods will be applied including focus group discussions, individual interviews and the usage of the think aloud technique and self-reported questionnaire data. The project is based on The International Patient Decision Aid Standards (IPDAS) framework and the proposed model development process for DAs. Individuals aged 23-74, including women (the cervical-, breast- and CRC screening module) and men (the CRC screening module), will be included in the developmental process. Efforts will be made to recruit participants with self-reported physical and mental limitations, individuals without a permanent residence and ethnic minorities. DISCUSSION To the best of our knowledge, the present study is the first attempt aimed at developing an iDA for use in the Swedish context. The iDA is intended to facilitate shared decision making about participation in screening. Furthermore, the iDA is expected to increase knowledge and raise awareness about cancer and cancer screening. PATIENT OR PUBLIC CONTRIBUTION Lay people are involved throughout the whole development and implementation process of the digital DA. TRIAL REGISTRATION NCT05512260.
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Affiliation(s)
- Kaisa Fritzell
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Hereditary Cancer Clinic, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Berith Hedberg
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Anke Woudstra
- Team Advies en Onderzoek, Municipal Health Service (GGD) Kennemerland, Haarlem, the Netherlands
| | - Anna Forsberg
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Anna Jervaeus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
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24
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Qu SX, Ni YH, Qin JF, Chen XY, Wu WL, Zhang WC. Experience and acceptability for HPV self-sampling among women in Jiangsu province, China: a cross-sectional survey. J OBSTET GYNAECOL 2023; 43:2204942. [PMID: 37129887 DOI: 10.1080/01443615.2023.2204942] [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: 05/03/2023]
Abstract
This aim of this study was to investigate women's knowledge about HPV along with their experience and acceptability of self-sampling in Jiangsu province, China. A total of 862 women aged 25-63 years old from Jiangsu province who purchased an HPV self-sampling test kit were invited to complete a questionnaire designed by the authors. Participants had high acceptability for HPV self-sampling with a mean score of 4.2 (95% [CI], 4.1-4.22) out of 5 points. 27% of participants preferred clinician-sampling, 33% preferred self-sampling, other 40% expressed no preference. Women with good knowledge about HPV and with a good experience with HPV self-sampling were more acceptable for self-sampling (P < 0.05). The biggest concern about HPV self-sampling of the participants includes 'specimens' spoilage', 'incorrect sampling', 'can't get results in time', and so on. HPV self-sampling can be used to improve cervical cancer screening coverage and participation rates in China.
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Affiliation(s)
- Shui-Xiang Qu
- Nursing Division, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Yi-Hua Ni
- Nursing Division, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Jian-Fen Qin
- Nursing Division, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Xiao-Yan Chen
- Nursing Division, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Wei-Li Wu
- Nursing Division, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Wei-Chu Zhang
- Nursing Division, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
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25
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Narvaez L, Viviano M, Dickson C, Jeannot E. The acceptability of HPV vaginal self-sampling for cervical cancer screening in Latin America: A systematic review. PUBLIC HEALTH IN PRACTICE 2023; 6:100417. [PMID: 37564780 PMCID: PMC10410574 DOI: 10.1016/j.puhip.2023.100417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
Objective This review summarizes women's acceptability of vaginal self-sampling for cervical cancer screening in Latin America. Study design Systematic review. Method A systematic literature search was performed in PubMed, Web of Science, and Embase regarding the acceptance of HPV vaginal self-sampling by women over 18 years old. Articles were selected for research that was conducted in Latin America and published between January 1st, 1993, and December 31st, 2022. Results Fifteen publications were included. Eight publications reported an acceptance of HPV self-sampling as high as 80%, six papers found an acceptance rate between 50 and 80% and only one found an acceptance rate of less than 50%. Based on non-standardized questionnaires, women considered self-sampling more comfortable, easier, and less painful than conventional cytology. The procedure was associated with less embarrassment and a greater sense of privacy. Conclusion HPV vaginal-self sampling appears to be an acceptable screening method amongst eligible Latin American women.
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Affiliation(s)
- Luisa Narvaez
- Institute of Global Health - Faculty of Medicine, Chemin de Mines 9, 1202, Geneva, Switzerland
| | - Manuela Viviano
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205, Geneva, Switzerland
| | - Cheryl Dickson
- Community Psychiatric Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Emilien Jeannot
- Institute of Global Health - Faculty of Medicine, Chemin de Mines 9, 1202, Geneva, Switzerland
- Community Psychiatric Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Jain M, Yadav D, Jarouliya U, Chavda V, Yadav AK, Chaurasia B, Song M. Epidemiology, Molecular Pathogenesis, Immuno-Pathogenesis, Immune Escape Mechanisms and Vaccine Evaluation for HPV-Associated Carcinogenesis. Pathogens 2023; 12:1380. [PMID: 38133265 PMCID: PMC10745624 DOI: 10.3390/pathogens12121380] [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: 10/01/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Human papillomavirus (HPV) is implicated in over 90% of cervical cancer cases, with factors like regional variability, HPV genotype, the population studied, HPV vaccination status, and anatomical sample collection location influencing the prevalence and pathology of HPV-induced cancer. HPV-16 and -18 are mainly responsible for the progression of several cancers, including cervix, anus, vagina, penis, vulva, and oropharynx. The oncogenic ability of HPV is not only sufficient for the progression of malignancy, but also for other tumor-generating steps required for the production of invasive cancer, such as coinfection with other viruses, lifestyle factors such as high parity, smoking, tobacco chewing, use of contraceptives for a long time, and immune responses such as stimulation of chronic stromal inflammation and immune deviation in the tumor microenvironment. Viral evasion from immunosurveillance also supports viral persistence, and virus-like particle-based prophylactic vaccines have been licensed, which are effective against high-risk HPV types. In addition, vaccination awareness programs and preventive strategies could help reduce the rate and incidence of HPV infection. In this review, we emphasize HPV infection and its role in cancer progression, molecular and immunopathogenesis, host immune response, immune evasion by HPV, vaccination, and preventive schemes battling HPV infection and HPV-related cancers.
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Affiliation(s)
- Meenu Jain
- Department of Microbiology, Viral Research and Diagnostic Laboratory, Gajra Raja Medical College, Gwalior 474009, Madhya Pradesh, India
| | - Dhananjay Yadav
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Republic of Korea;
| | - Urmila Jarouliya
- SOS in Biochemistry, Jiwaji University, Gwalior 474011 Madhya Pradesh, India;
| | - Vishal Chavda
- Department of Pathology, Stanford School of Medicine, Stanford University Medical Center, Palo Alto, CA 94305, USA;
| | - Arun Kumar Yadav
- Department of Microbiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot 151203, Punjab, India;
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj 44300, Nepal;
| | - Minseok Song
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Republic of Korea;
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Le Goff J, Le Duc-Banaszuk AS, Lefeuvre C, Pivert A, Ducancelle A, De Pauw H, Arbyn M, Vinay A, Rexand-Galais F. Acceptability to Healthcare Professionals of Home-Based HPV Self-Sampling for Cervical Screening: A French Qualitative Study Conducted in an Area with Low Access to Health Services. Cancers (Basel) 2023; 15:5163. [PMID: 37958337 PMCID: PMC10648237 DOI: 10.3390/cancers15215163] [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: 09/26/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Self-sampling may improve participation in cervical cancer secondary prevention programs by women who do not respond or respond irregularly when invited to contact a health professional for the collection of a cervical specimen. It could also help resolve access problems in areas with a low physician density. The present qualitative study examined barriers to screening, effective screening strategies, and the advantages and disadvantages of sending women urine or vaginal self-sampling kits in two medically underserved administrative departments in France (Mayenne and Sarthe) showing low cervical screening coverage. As part of the CapU4 randomized trial, a team of psychologists investigated the attitudes and experiences of 59 healthcare professionals (gynecologists, general practitioners, and midwives) through semi-structured interviews. Results indicated that health professionals believe that self-sampling may address the issues of low physician density and underscreening by removing logistical, organizational, financial, and psychological obstacles. They confirmed trust in the use of vaginal self-sampling, with urine self-sampling as an alternative solution (e.g., for women with vaginismus). The health professionals also identified several limitations of the self-sampling kit that will need to be addressed in future screening campaigns (incomplete kit, complex instructions, poor anatomical knowledge, and obesity).
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Affiliation(s)
- Johane Le Goff
- University of Angers, CLIPSY, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
| | - Anne-Sophie Le Duc-Banaszuk
- Pays de la Loire Regional Cancer Screening Coordination Center (CRCDC Pays de La Loire), F-49000 Angers, France;
| | - Caroline Lefeuvre
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Adeline Pivert
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Alexandra Ducancelle
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Hélène De Pauw
- Cancer Epidemiology Unit, Belgian Cancer Center, Sciensano, 1050 Brussels, Belgium; (H.D.P.); (M.A.)
| | - Marc Arbyn
- Cancer Epidemiology Unit, Belgian Cancer Center, Sciensano, 1050 Brussels, Belgium; (H.D.P.); (M.A.)
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Aubeline Vinay
- University of Angers, CLIPSY, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
| | - Franck Rexand-Galais
- University of Angers, CLIPSY, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
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Beaverson S, Cyrus JW, Huffstetler AN. Concordance of Primary Human Papillomavirus Testing Among Clinicians and Patients: A Systematic Review. J Womens Health (Larchmt) 2023; 32:1062-1072. [PMID: 37582276 PMCID: PMC10623466 DOI: 10.1089/jwh.2023.0125] [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: 08/17/2023] Open
Abstract
Objective: Primary high risk human papilloma virus (hrHPV) testing is recommended as first-line screening for cervical cancer. Testing involves either a clinician-collected or a self-collected cervicovaginal swab. This study examines concordance between methods of collection of primary HPV testing. Methods: Ovid MEDLINE, Ovid Embase, and Cochrane were searched for relevant studies on self-collected and clinician-collected primary HPV testing published before December 31, 2022. English-language studies for primary HPV testing of average-risk patients were included. Studies conducted in screening settings rather than colposcopy clinics, that used standard devices for HPV collection, and that directly compared methods of collection were included. Outcomes were concordance and kappa between paired samples, and rate of HPV detection in self-collected and clinician-collected samples. Results: A total of 2381 studies were screened, of which 228 were included for full-text evaluation. Thirty-six studies, including 23,328 individuals screened, met the inclusion criteria. The rate of HPV detection ranged from 4.7% to 63% for self-collection and from 3.7% to 62% for clinician-collection. The concordance ranged from 78.2% to 96.9%, and kappa had substantial agreement for 26 of the 36 studies and moderate agreement for 7 of the 36 studies. Conclusions: This study directly compares clinician-collected and self-collected primary HPV screening rates. Studies were conducted in methods which are widely reproducible in the primary care setting. Primary HPV self-collection is a reliable and accurate method for cervical cancer screening.
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Affiliation(s)
- Sarah Beaverson
- School of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - John W. Cyrus
- Health Sciences Library, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alison N. Huffstetler
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
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Nair V, Dau H, Vidler M, AboMoslim M, Mutamba B, Scott M, Nesbitt Z, Deodatha J, Byiringiro SD, Niyotwiringiye C, Mithani N, Smith L, Ogilvie G, Rulisa S. Understanding the cervical cancer self-collection preferences of women living in urban and rural Rwanda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002135. [PMID: 37768884 PMCID: PMC10538759 DOI: 10.1371/journal.pgph.0002135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
Cervical cancer is a leading cause of cancer among women in low- and middle-income countries. Women in Rwanda have high rates of cervical cancer due to limited access to effective screening methods. Research in other low-resource settings similar to Rwanda has shown that HPV-based self-collection is an effective cervical cancer screening method. This study aims to compare the preferences of Rwandan women in urban and rural settings toward self-collection and to report on factors related to self-collection amenability. A cross-sectional survey was conducted from June 1-9, 2022. Women were recruited from one urban and one rural clinic in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. The survey consisted of 51 questions investigating demographics and attitudes towards self-collection for cervical cancer screening. We reported descriptive statistics stratified by urban and rural sites. In total, 169 urban and 205 rural women completed the survey. The majority of respondents at both sites had a primary school or lower education and were in a relationship. Both urban and rural respondents were open to self-collection; however, rates were higher in the rural site (79.9% urban and 95.6% rural; p-value<0.001). Similarly, women in rural areas were more likely to report feeling unembarrassed about self-collection (65.3% of urban, 76.8% of rural; p-value<0.001). Notably, almost all urban and rural respondents (97.6% urban and 98.5% rural) stated they would go for a cervical cancer pelvic examination to a nearby health center if their self-collected results indicated any concern (p-value = 0.731). Rwandan women in both urban and rural areas largely support self-collection for cervical cancer screening. Further research is needed to better understand how to implement self-collection screening services in Rwanda.
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Affiliation(s)
- Varun Nair
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- Integrated Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hallie Dau
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryam AboMoslim
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Zoey Nesbitt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Nadia Mithani
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie Smith
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, Canada
| | - Gina Ogilvie
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, Canada
| | - Stephen Rulisa
- School of Medicine and Pharmacy, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
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Taghavi K, Zhao F, Downham L, Baena A, Basu P. Molecular triaging options for women testing HPV positive with self-collected samples. Front Oncol 2023; 13:1243888. [PMID: 37810963 PMCID: PMC10560038 DOI: 10.3389/fonc.2023.1243888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
We review developments in molecular triaging options for women who test positive for high-risk human papillomavirus (hrHPV) on self-collected samples in the context of cervical cancer elimination. The World Health Organization (WHO) recommends hrHPV screening as the primary test for cervical screening due to its high sensitivity compared to other screening tests. However, when hrHPV testing is used alone for treatment decisions, a proportion of women of childbearing age receive unnecessary treatments. This provides the incentive to optimize screening regimes to minimize the risk of overtreatment in women of reproductive age. Molecular biomarkers can potentially enhance the accuracy and efficiency of screening and triage. HrHPV testing is currently the only screening test that allows triage with molecular methods using the same sample. Additionally, offering self-collected hrHPV tests to women has been reported to increase screening coverage. This creates an opportunity to focus health resources on linking screen-positive women to diagnosis and treatment. Adding an additional test to the screening algorithm (a triage test) may improve the test's positive predictive value (PPV) and offer a better balance of benefits and risks for women. Conventional triage methods like cytology and visual inspection with acetic acid (VIA) cannot be performed on self-collected samples and require additional clinic visits and subjective interpretations. Molecular triaging using methods like partial and extended genotyping, methylation tests, detection of E6/E7 proteins, and hrHPV viral load in the same sample as the hrHPV test may improve the prediction of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and invasive cancer, offering more precise, efficient, and cost-effective screening regimes. More research is needed to determine if self-collected samples are effective and cost-efficient for diverse populations and in comparison to other triage methods. The implementation of molecular triaging could improve screening accuracy and reduce the need for multiple clinical visits. These important factors play a crucial role in achieving the global goal of eliminating cervical cancer as a public health problem.
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Affiliation(s)
- Katayoun Taghavi
- Early Detection, Prevention and Infections Branch, International Agency For Research On Cancer (IARC), Lyon, France
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Laura Downham
- Early Detection, Prevention and Infections Branch, International Agency For Research On Cancer (IARC), Lyon, France
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency For Research On Cancer (IARC), Lyon, France
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency For Research On Cancer (IARC), Lyon, France
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31
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Liebermann E, Fontenot HB, Lim E, Matsunaga M, Zimet G, Allen JD. Preferred Location for Human Papillomavirus Self-Sampling for Cervical Cancer Screening. J Obstet Gynecol Neonatal Nurs 2023; 52:364-373. [PMID: 37355248 DOI: 10.1016/j.jogn.2023.05.114] [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: 02/02/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE To examine associations among women's preferred locations for human papillomavirus (HPV) self-sampling in relation to their demographic, social, and health characteristics and their perceived benefits and concerns regarding this procedure. DESIGN Cross-sectional, descriptive survey. SETTING Online distribution between March 2022 and April 2022. PARTICIPANTS People who were assigned female sex at birth and were eligible for cervical cancer screening (N = 367: cis-gender women, n = 364; another gender identity, n = 3). METHODS We used quota sampling to obtain a racially and ethnically diverse sample. We conducted bivariate analyses to examine differences in participants' preferred locations for HPV self-sampling by sociodemographic and health characteristics. We used a multinomial logistic regression model to examine the associations between preferred HPV self-sampling location, characteristics of participants, and perceived benefits and concerns regarding this procedure. RESULTS In our sample, 43% (n = 158) of participants preferred HPV self-sampling at the office of a health care provider, 50% (n = 182) preferred HPV self-sampling anywhere (office or home), and 7% (n = 27) did not feel comfortable with HPV self-sampling anywhere. Participants 39 to 45 years of age were more likely to prefer HPV self-sampling anywhere (office or home) than participants 27 to 32 years of age, OR = 2.47, 95% confidence interval (CI) [1.21, 5.06]. Participants who preferred HPV self-sampling anywhere perceived greater benefit related to limited geographic access to a clinic compared to those who preferred office only, OR = 1.82, 95% CI [1.08, 3.07]. Participants who preferred HPV self-sampling anywhere had less concern related to performing the procedure accurately than those who preferred office only, OR = 0.44, 95% CI [0.31, 0.62]. CONCLUSION HPV self-sampling is an alternative strategy to increase cervical cancer screening. As providers consider implementation of HPV self-sampling, our findings suggest that office and home-based collection strategies should be considered to increase access to cervical cancer screening.
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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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Haward B, Tatar O, Zhu P, Griffin-Mathieu G, McBride E, Waller J, Brotherton J, Lofters A, Mayrand MH, Perez S, Rosberger Z. Are Canadian Women Prepared for the Transition to Primary HPV Testing in Cervical Screening? A National Survey of Knowledge, Attitudes, and Beliefs. Curr Oncol 2023; 30:7055-7072. [PMID: 37504372 PMCID: PMC10378227 DOI: 10.3390/curroncol30070512] [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: 06/20/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
As Canadian provinces and territories prepare to transition to HPV-based primary screening for cervical cancer, failure to identify and address potential barriers to screening could hinder program implementation. We examined screening-eligible Canadians' attitudes towards and knowledge of cervical screening. A nationally representative sample of screening-eligible Canadians (N = 3724) completed a web-based survey in the summer of 2022. Oversampling ensured that half of the sample were underscreened for cervical cancer (>3 years since previous screening or never screened). The participants completed validated scales of cervical cancer, HPV, and HPV test knowledge and HPV test and self-sampling attitudes and beliefs. Between-group differences (underscreened vs. adequately screened) were calculated for scales and items using independent sample t-tests or chi-square tests. The underscreened participants (n = 1871) demonstrated significantly lower knowledge of cervical cancer, HPV, and the HPV test. The adequately screened participants (n = 1853) scored higher on the Confidence and Worries subscales of the HPV Test Attitudes and Beliefs Scale. The underscreened participants scored higher on the Personal Barriers and Social Norms subscales. The underscreened participants also endorsed greater Autonomy conferred by self-sampling. Our findings suggest important differential patterns of knowledge, attitudes, and beliefs between the underscreened and adequately screened Canadians. These findings highlight the need to develop targeted communication strategies and promote patient-centered, tailored approaches in cervical screening programs.
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Affiliation(s)
- Ben Haward
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
| | - Patricia Zhu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Emily McBride
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9NH, UK
| | - Julia Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VI 3010, Australia
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Marie-Hélène Mayrand
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
- Département d'Obstétrique-Gynécologie, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Samara Perez
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Departments of Psychology and Psychiatry, McGill University, Montreal, QC H3A 1G1, Canada
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34
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Basagoitia A, Burrowes S, Solis-Soto MT, MacMillan G, Sullivan S. Community and provider perceptions and experiences of cervical cancer screening in Rural Bolivia: a qualitative study. BMC Womens Health 2023; 23:359. [PMID: 37407967 PMCID: PMC10324272 DOI: 10.1186/s12905-023-02500-2] [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: 03/04/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Despite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver Universal Health Care, the Bolivian government needs information on the factors constraining cervical cancer screening access and utilization, especially in rural areas. METHODS Our qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n = 80) and interviews with healthcare providers (n = 6) in four purposively selected rural communities in Hernando Siles, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software. RESULTS Four themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members' lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Suggestions for improvements included more intensive cervical cancer outreach to rural areas and having specialists train lower-level providers to perform screening. CONCLUSIONS Our findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-sampling into screening protocols, and the implementation of programs to improve community confidence in providers' ability to perform screening.
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Affiliation(s)
- Armando Basagoitia
- Salud Global, Urriolagoitia #354 Primer Piso Urriolagoitia 354, Sucre, Bolivia
| | - Sahai Burrowes
- Touro University California Public Health Program, CEHS, 1310 Club Drive Vallejo, Vallejo, CA 94592 USA
| | | | - Genevieve MacMillan
- Touro University California Public Health Program, CEHS, 1310 Club Drive Vallejo, Vallejo, CA 94592 USA
| | - Sarah Sullivan
- Touro University California Public Health Program, CEHS, 1310 Club Drive Vallejo, Vallejo, CA 94592 USA
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Zigras T, Mayrand MH, Bouchard C, Salvador S, Eiriksson L, Almadin C, Kean S, Dean E, Malhotra U, Todd N, Fontaine D, Bentley J. Canadian Guideline on the Management of a Positive Human Papillomavirus Test and Guidance for Specific Populations. Curr Oncol 2023; 30:5652-5679. [PMID: 37366908 DOI: 10.3390/curroncol30060425] [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: 05/11/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
The purpose of this paper is to provide evidence-based guidance on the management of a positive human papilloma virus (HPV) test and to provide guidance around screening and HPV testing for specific patient populations. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC), and the Canadian Partnership Against Cancer. The literature informing these guidelines was obtained through a systematic review of relevant literature by a multi-step search process led by an information specialist. The literature was reviewed up to July 2021 with manual searches of relevant national guidelines and more recent publications. The quality of the evidence and strength of recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include primary care providers, gynecologists, colposcopists, screening programs, and healthcare facilities. The implementation of the recommendations will ensure an optimum implementation of HPV testing with a focus on the management of positive results. Recommendations for appropriate care for underserved and marginalized groups are made.
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Affiliation(s)
- Tiffany Zigras
- Trillium Health Partners, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Marie-Hélène Mayrand
- Département d'obstétrique-gynécologie, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Celine Bouchard
- Clinique de Researche en Sante des femmes, Quebec City, QC G1V 3M7, Canada
| | - Shannon Salvador
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Lua Eiriksson
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Chelsea Almadin
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC H3Z 2H5, Canada
| | - Sarah Kean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Winnipeg, MB R3J 3T7, Canada
| | - Erin Dean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Winnipeg, MB R3J 3T7, Canada
| | - Unjali Malhotra
- Office of the Chief Medical Officer, First Nations Health Authority, West Vancouver, BC V7T 1A2, Canada
| | - Nicole Todd
- Department of Obstetrics and Gynecology UBC, Vancouver, BC V5Z 4E1, Canada
| | - Daniel Fontaine
- Department of Pathology and Laboratory Medicine, Valley Regional Hospital, Kentville, NS B4N 5E3, Canada
| | - James Bentley
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS B3H 4R2, Canada
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36
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Milano G, Guarducci G, Nante N, Montomoli E, Manini I. Human Papillomavirus Epidemiology and Prevention: Is There Still a Gender Gap? Vaccines (Basel) 2023; 11:1060. [PMID: 37376449 DOI: 10.3390/vaccines11061060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND AIM Human papillomavirus (HPV) is sexually transmitted, one of the three most common sexually transmitted infections (STIs) in both males and females, and the most common viral STI. A crucial public health strategy to protect people against HPV is vaccination, which has shown its effectiveness in preventing HPV-related diseases. Presently, three types of vaccines are available (bivalent, quadrivalent, and nonvalent), and they all target the two most oncogenic virus genotypes (HPV 16 and 18). In recent years, the need to implement vaccination programmes that include all genders has been discussed in order to achieve herd immunity against HPV. To date, only a few countries have included young males in their vaccination programmes. Thus, our objective with this review is to provide an overview of the epidemiology of HPV and HPV prevention strategies and report the latest findings from the scientific literature.
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Affiliation(s)
- Giovanna Milano
- Department of Life Sciences, University of Siena, 53100 Siena, Italy
| | - Giovanni Guarducci
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
- VisMederi S.r.l., 53100 Siena, Italy
- Interuniversity Research Centre on Influenza and Other Transmissible Infections (CIRI-IT), 16132 Genoa, Italy
| | - Ilaria Manini
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
- Interuniversity Research Centre on Influenza and Other Transmissible Infections (CIRI-IT), 16132 Genoa, Italy
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37
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Tang JH, Lee F, Chagomerana MB, Ghambi K, Mhango P, Msowoya L, Mkochi T, Magongwa I, Mhango E, Mbendera J, Mwandira E, Schouten E, Gardner L, Smith JS, Gadama L, Chinula L. Results from Two HPV-Based Cervical Cancer Screening-Family Planning Integration Models in Malawi: A Cluster Randomized Trial. Cancers (Basel) 2023; 15:2797. [PMID: 37345135 DOI: 10.3390/cancers15102797] [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: 04/03/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
We conducted a cluster randomized trial of two models for integrating HPV self-collection into family-planning (FP) services at 16 health facilities in Malawi between March 2020-December 2021. Model 1 involved providing only clinic-based HPV self-collection, whereas Model 2 included both clinic-based and community-based HPV self-collection. An endline household survey was performed in sampled villages and households between October-December 2021 in the catchment areas of the health facilities. We analyzed 7664 surveys from 400 villages. Participants from Model 2 areas were more likely to have ever undergone cervical cancer screening (CCS) than participants from Model 1 areas, after adjusting for district, facility location (urban versus rural), and facility size (hospital versus health center) (adjusted odds ratio = 1.73; 95% CI: 1.29, 2.33). Among participants who had ever undergone CCS, participants from Model 2 were more likely to report having undergone HPV self-collection than participants from Model 1 (50.5% versus 22.8%, p = 0.023). Participants from Model 2 were more likely to be using modern FP (adjusted odds ratio = 1.01; 95% CI: 1.41, 1.98) than Model 1 participants. The integration of FP and HPV self-collection in both the clinic and community increases CCS and modern FP uptake more than integration at the clinic-level alone.
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Affiliation(s)
- Jennifer H Tang
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, 4002 Old Clinic Building, Chapel Hill, NC 27599, USA
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
| | - Fan Lee
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, 4002 Old Clinic Building, Chapel Hill, NC 27599, USA
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
| | - Maganizo B Chagomerana
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill, 321 South Columbia Street, Chapel Hill, NC 27599, USA
| | - Kachengwa Ghambi
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
| | - Patani Mhango
- Department of Obstetrics & Gynaecology, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre 312225, Malawi
| | - Lizzie Msowoya
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
| | - Tawonga Mkochi
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
| | - Irene Magongwa
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
| | - Eneli Mhango
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
| | - Jacqueline Mbendera
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
| | - Eunice Mwandira
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
| | - Erik Schouten
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
| | - Leah Gardner
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, 4002 Old Clinic Building, Chapel Hill, NC 27599, USA
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA
| | - Luis Gadama
- Department of Medicine, University of North Carolina at Chapel Hill, 321 South Columbia Street, Chapel Hill, NC 27599, USA
| | - Lameck Chinula
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, 4002 Old Clinic Building, Chapel Hill, NC 27599, USA
- UNC Project-Malawi, Tidziwe Center, Kamuzu Central Hospital, 100 Mzimba Road, Lilongwe 207233, Malawi
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Lichtenfels M, Lorenzi NPC, Tacla M, Yokochi K, Frustockl F, Silva CA, Silva ALD, Termini L, Farias CB. A New Brazilian Device for Cervical Cancer Screening: Acceptability and Accuracy of Self-sampling. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:235-241. [PMID: 37339642 PMCID: PMC10281768 DOI: 10.1055/s-0043-1770134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE To evaluate the accuracy and patient acceptability toward self-sampling using a new device - SelfCervix® - for detecting HPV-DNA. METHODS A total of 73 women aged 25-65 who underwent regular cervical cancer screening from March to October 2016 were included. Women performed self-sampling followed by a physician-sampling, and the samples were analyzed for HPV-DNA. After that, patients were surveyed about their acceptability of self-sampling. RESULTS HPV-DNA detection rate of self-sampling presented high accuracy and was similar to physician-collection. Sixty-four (87.7%) patients answered the acceptability survey. Most patients (89%) considered the self-sampling comfortable, and 82.5% preferred self-sampling to physician-sampling. The reasons cited were time-saving and convenience. Fifty-one (79.7%) reported that they would recommend self-sampling. CONCLUSION Self-sampling using the new Brazilian device SelfCervix® is not inferior in HPV-DNA detection rate compared with physician-collection, and patients are supportive of the method. Therefore, it might be an option to reach under-screened populations in Brazil.
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Affiliation(s)
| | | | - Maricy Tacla
- Department of Gynecology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Kaori Yokochi
- Department of Gynecology, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | | | | | - André Luiz da Silva
- Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Lara Termini
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Perkins R, Mitchell E. Cervical cancer disparities. J Natl Med Assoc 2023; 115:S19-S25. [PMID: 37202000 DOI: 10.1016/j.jnma.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/01/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Rebecca Perkins
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, United States
| | - Edith Mitchell
- Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA, United States.
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Vahabi M, Mishra G, Pimple S, Wong JPH, Khan M, Prakash V, Anand K, Narushima M, Lofters AK. Effectiveness of family-centred sexual health education and HPV self-sampling in promoting cervical cancer screening among hard-to-reach indian women in rural and tribal areas: a community-based pilot study. BMC Public Health 2023; 23:671. [PMID: 37041530 PMCID: PMC10088194 DOI: 10.1186/s12889-023-15602-1] [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: 12/23/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND While cervical cancer deaths have declined steeply in high-income countries due to the widespread use of the Papanicolaou test (Pap test), the same trend has not emerged in low or middle-income countries (LMICs). Access to screening in LMICs like India is limited due to barriers such as limited healthcare infrastructures, lack of sexual health education, and stigma demarcating sexually transmitted infections (STIs). HPV self-sampling (HPV-SS), a woman-centered and at-home method for screening, can be utilized as a unique screening tool to overcome some of these barriers. Our study examined the effectiveness of HPV-SS, supported by family-centred arts-based sexual health literacy on the uptake of cervical cancer screening among hard-to-reach women in rural and remote areas in India. METHODS Our community-based mixed methods pilot study recruited 240 participants (120 women and 120 male partners or family members) through female Accredited Social Health Activists (ASHA) across 3 Indian villages of Shirgoan, Khodala, and Jamsar in Palghar district. Inclusion criteria included women ages 30-69 who were under or never screened (UNS) and their male partners/family members aged 18 or over. Knowledge and attitudes about cervical cancer and screening and their perceived stigma surrounding STI were assessed using validated scales prior to and after attending a 2-hour arts-based sexual health education (SHE). In addition, participants' uptake of cervical cancer screening was assessed after attendance in SHE. FINDINGS Results revealed significant improvement in knowledge and attitudes about cervical cancer and screening, and a reduction in the STI stigma after participation in SHE sessions (overall mean difference in Knowledge: z = 6.1 ± 2.4, P < 0.001; attitudes about Pap-test and VIA: z = 2.2 ± 8.4, P < 0.001 and z = 2.9 ± 8.2, P < 0.001; STI stigma: z = 2.8 ± 12.4, P < 0.001). 118 out of 120 female participants chose to be screened and 115 opted for HPV-SS. CONCLUSIONS The implementation of HPV-SS coupled with family-centered arts-based and culturally appropriate SHE is highly promising in promoting cervical cancer screening among hard-to-reach women. Evidence from our study can be used to advance public health policies and inform the scale-up of similar initiatives in other villages and states across rural India and other LMICs.
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Affiliation(s)
- Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, 4 Josephine Pui-Hing Wong, 350 Victoria Street, M5B 2K3, Toronto, ON, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
| | - Gauravi Mishra
- Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), R. No. 314, 3rd Floor, Service Block, E Borges Marg, Mumbai, 400012, Maharashtra, India
| | - Sharmila Pimple
- Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), R. No. 314, 3rd Floor, Service Block, E Borges Marg, Mumbai, 400012, Maharashtra, India
| | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Ryerson University, 4 Josephine Pui-Hing Wong, 350 Victoria Street, M5B 2K3, Toronto, ON, Canada
- Dalla Lana School of Public Health (Cross-appointed), University of Toronto, Toronto, ON, Canada
| | - Momina Khan
- Daphne Cockwell School of Nursing, Ryerson University, 4 Josephine Pui-Hing Wong, 350 Victoria Street, M5B 2K3, Toronto, ON, Canada
| | - Vijayshree Prakash
- Daphne Cockwell School of Nursing, Ryerson University, 4 Josephine Pui-Hing Wong, 350 Victoria Street, M5B 2K3, Toronto, ON, Canada
| | - Kavita Anand
- Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), R. No. 314, 3rd Floor, Service Block, E Borges Marg, Mumbai, 400012, Maharashtra, India
| | | | - Aisha K Lofters
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, St. Catharines, Canada
- Women's College Hospital Research Institute, Peter Gilgan Centre for Women's Cancers, Toronto, Canada
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Higashi RT, Tiro JA, Winer RL, Ornelas IJ, Bravo P, Quirk L, Kessler LG. Understanding the effect of new U.S. cervical cancer screening guidelines and modalities on patients' comprehension and reporting of their cervical cancer screening behavior. Prev Med Rep 2023; 32:102169. [PMID: 36922960 PMCID: PMC10009194 DOI: 10.1016/j.pmedr.2023.102169] [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: 11/06/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
With recent shifts in guideline-recommended cervical cancer screening in the U.S., it is important to accurately measure screening behavior. Previous studies have indicated the U.S. National Health Interview Survey (NHIS), a resource for measuring self-reported screening adherence, has lower validity among non-White racial/ethnic groups and non-English speakers. Further, measuring diverse population groups' comprehension of items and attitudes toward HPV self-sampling merits investigation as it is a modality likely to be recommended in the U.S. soon. This study cognitively tested NHIS items assessing recency of and reasons for receiving cervical cancer screening and attitudes toward HPV self-sampling. We conducted cognitive interviews between April 2021 - April 2022 in English and Spanish with individuals screened in the past two years by either a medical center in metropolitan Seattle, Washington or a safety-net healthcare system in Dallas, Texas. Interviews probed understanding of reasons for screening, experiences with abnormal results, and interest in HPV self-sampling. We completed 32 interviews in Seattle and 42 interviews in Dallas. A majority of participants were unaware that two different tests for cervical cancer screening exist (Pap and HPV). Many did not know which type(s) of test they received. Dallas participants had more limited and inaccurate knowledge of HPV compared to Seattle participants, and fewer responded favorably toward HPV self-sampling (32% vs. 55%). To improve comprehension and accurate reporting of cervical cancer screening, we suggest specific refinements to currently used survey questions. Attitudes toward self-sampling should be explored further as differences may exist by region and/or sociodemographic factors.
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Affiliation(s)
- Robin T Higashi
- University of Texas Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.,Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX, 75235, USA
| | - Jasmin A Tiro
- University of Texas Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.,Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX, 75235, USA
| | - Rachel L Winer
- University of Washington, Department of Epidemiology, Box 351619, 3980 15th Ave NE, Seattle, WA 98195, USA.,Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA
| | - India J Ornelas
- University of Washington, Department of Health Systems and Population Health, School of Public Health, 3980 15th Ave NE, UW Box 351621, Seattle, WA 98195, USA
| | - Perla Bravo
- University of Washington, Department of Health Systems and Population Health, School of Public Health, 3980 15th Ave NE, UW Box 351621, Seattle, WA 98195, USA
| | - Lisa Quirk
- University of Texas Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Larry G Kessler
- University of Washington, Department of Health Systems and Population Health, School of Public Health, 3980 15th Ave NE, UW Box 351621, Seattle, WA 98195, USA
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Hinzmann R. Direct-to-consumer testing - benefits for consumers, people with disease and public health. Clin Chem Lab Med 2023; 61:703-708. [PMID: 36735550 DOI: 10.1515/cclm-2023-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
Direct-to-consumer (DTC) tests can be defined as any in-vitro diagnostic (IVD) test or, more broadly, any medical test using an IVD or medical device, that is marketed directly to consumers without involvement of a health care provider (HCP). Examples are pregnancy tests, alcohol breath tests, blood pressure measurements (medical device), coagulation tests (INR), self-monitoring of blood glucose, continuous glucose monitoring (medical device), HIV tests, HPV tests, SARS-CoV-2 antigen tests, or genetic tests. DTC tests fulfil various customer needs such as making rapid decisions (e.g. glucose monitoring for insulin dosing, SARS-CoV-2 antigen test, hormone test identifying fertile days, alcohol test), monitoring chronic conditions between consultations (e.g. diabetes, lipidaemia, hypertension), saving time and reducing consultations (e.g. INR, SARS-CoV-2 antigen test, blood pressure monitoring), screening for disease when no symptoms are present (e.g. occult blood, cholesterol, triglycerides, SARS-CoV2 antigen test), or maintaining privacy (e.g. pregnancy test, HIV test, HPV test, certain genetic tests). Further, DTC tests can reduce cost and expand access to care in countries with limited resources and can support healthcare systems in extraordinary circumstances such as a pandemic. Valid concerns about DTC testing need to be described, addressed and resolved with the help of authorities and regulators in collaboration with HCP and should not detract from the advantages DTC tests can provide. HCP should play a more prominent role in educating the public through mass media and social media on the proper use of DTC tests and help to pinpoint problem areas.
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Ruel-Laliberté J, Jacob-Wagner M, Bestman-Smith J, Paré J. Acceptability and preferences of dry HPV-HR self-sampling mailed kits among Canadian women: a cross-sectional study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:261-266. [PMID: 36870436 DOI: 10.1016/j.jogc.2023.02.012] [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: 12/16/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/06/2023]
Abstract
Human papillomavirus (HPV), a sexually transmitted disease, is identified as the source of 99.7% of cervical cancers. Screening for cervical cancer using oncogenic HPV (HR HPV) detection is more sensitive than traditional cytology. However, few Canadian data exist on HR HPV self-sampling. OBJECTIVE To evaluate the acceptability of HR HPV self-sampling by patients, the percentage of correctly collected samples, the return rate of mailed kits, and the HPV positivity rate in a population sample based on different cervical cancer risk factors. METHODS We conducted an observational cross-sectional study on HPV primary cervical cancer screening with self-collected cervicovaginal samples through mail service. RESULTS Four hundred kits were mailed and 310 kits were returned; this therefore makes a return rate of 77.5%. Of these, 84.2% of patients were very satisfied with this method and 95.8% (297/310) of patients would choose self-sampling over cytology as their primary screening method. All patients would recommend this screening method to their friend or family member. 93.8% of the samples could be analyzed correctly and the HPV positivity rate was 11.7%. CONCLUSION In this large and random sample, there was a strong interest in self-testing. Offering HR HPV self-sampling could increase access to cervical cancer screening. The self-screening method could also be a part of the solution to reach under-screened populations, in particular those who do not have a family doctor or avoid gynaecologic exams because of pain or anxiety.
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Affiliation(s)
| | - Marieve Jacob-Wagner
- CHU de Québec - Université Laval, Department of Microbiology and Infectious Diseases, Québec, QC
| | - Julie Bestman-Smith
- CHU de Québec - Université Laval, Department of Microbiology and Infectious Diseases, Québec, QC
| | - Josianne Paré
- Department of Obstetrics & Gynaecology, Université de Sherbrooke, Sherbrooke, QC
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Arrivillaga M, Bermúdez PC, García-Cifuentes JP, Rodríguez-López M, Neira D, Vargas-Cardona HD. Women's critical experiences with the pap smear for the development of cervical cancer screening devices. Heliyon 2023; 9:e14289. [PMID: 36938419 PMCID: PMC10018556 DOI: 10.1016/j.heliyon.2023.e14289] [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: 10/13/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
Global cervical cancer incidence and mortality have remained a major public health problem. Depending on the quality and coverage of preventive programs, and the capacity of health care systems, different screening tests are used, with the Pap smear being the most widely implemented. Several difficulties have been reported in accessing timely detection, causing late cervical cancer diagnosis. Trying to close these gaps, new screening devices have been developed in recent years; however, there is a lack of knowledge about whether or not women perspective has been included in the design process and technological development of these devices. This scoping review aimed to describe and synthesize scientific literature on women's critical experiences with Pap smears to prospectively contribute to the design, development, and scale-up of cervical cancer screening devices. The electronic databases Web of Science, Scopus, PubMed, PsycINFO and SciELO were searched for relevant studies published between 2012 and 2021; finally, 18 qualitative studies were included. Experiences were classified into four categories: fear and embarrassment, speculum pain and discomfort, outcome distress and health service barriers. Critical experiences before, during, and after the test were analyzed in turn. In particular, during the test, women reported pain associated with the use of the speculum. The acceptability of new screening devices will largely depend on comfort during the test and timely delivery of results. This review provides a useful qualitative synthesis, not only to advance the design of novel devices but also for future implementation research in cervical screening services.
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Affiliation(s)
- Marcela Arrivillaga
- Pontificia Universidad Javeriana - Cali, Valle, Colombia. Calle 18 118-250, Cali Valle, Colombia
| | - Paula C. Bermúdez
- Pontificia Universidad Javeriana - Cali, Valle, Colombia. Calle 18 118-250, Cali Valle, Colombia
| | | | | | - Daniela Neira
- Red de Salud Ladera ESE - Alcaldía de Cali, Cali, Colombia. Calle 5C 39-51, Cali, Valle, Colombia
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45
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Costa S, Verberckmoes B, Castle PE, Arbyn M. Offering HPV self-sampling kits: an updated meta-analysis of the effectiveness of strategies to increase participation in cervical cancer screening. Br J Cancer 2023; 128:805-813. [PMID: 36517552 PMCID: PMC9977737 DOI: 10.1038/s41416-022-02094-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) testing on self-samples represents a great opportunity to increase cervical cancer screening uptake among under-screened women. METHODS A systematic review and meta-analysis on randomised controlled trials (RCTs) were performed to update the evidence on the efficacy of strategies for offering self-sampling kits for HPV testing compared to conventional invitations and to compare different self-sampling invitation scenarios. Four experimental invitational scenarios were considered. Women in the control group were invited for screening according to existing practice: collection of a cervical specimen by a healthcare professional. Random-effects models were used to pool proportions, relative participation rates and absolute participation differences. RESULTS Thirty-three trials were included. In the intention-to-treat analysis, all self-sampling invitation scenarios were more effective in reaching under-screened women compared to controls. Pooled participation difference (PD) and 95% confidence interval (CI) for experimental vs. control was 13.2% (95% CI = 11.0-15.3%) for mail-to-all, 4.4% (95% CI = 1.2-7.6%) for opt-in, 39.1% (95% CI = 8.4-69.9%) for community mobilisation & outreach and 28.1% (23.5-32.7%) for offer at healthcare service. PD for the comparison opt-in vs. mail-to-all, assessed in nine trials, was -8.2% (95% CI = -10.8 to -5.7%). DISCUSSION Overall, screening participation was higher among women invited for self-sampling compared to control, regardless of the invitation strategy used. Opt-in strategies were less effective than send-to-all strategies.
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Affiliation(s)
- Stefanie Costa
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Bo Verberckmoes
- International Centre for Reproductive Health, Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Tatar O, Haward B, Zhu P, Griffin-Mathieu G, Perez S, McBride E, Lofters AK, Smith LW, Mayrand MH, Daley EM, Brotherton JML, Zimet GD, Rosberger Z. Understanding the Challenges of HPV-Based Cervical Screening: Development and Validation of HPV Testing and Self-Sampling Attitudes and Beliefs Scales. Curr Oncol 2023; 30:1206-1219. [PMID: 36661742 PMCID: PMC9858121 DOI: 10.3390/curroncol30010093] [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: 12/09/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
The disrupted introduction of the HPV-based cervical screening program in several jurisdictions has demonstrated that the attitudes and beliefs of screening-eligible persons are critically implicated in the success of program implementation (including the use of self-sampling). As no up-to-date and validated measures exist measuring attitudes and beliefs towards HPV testing and self-sampling, this study aimed to develop and validate two scales measuring these factors. In October-November 2021, cervical screening-eligible Canadians participated in a web-based survey. In total, 44 items related to HPV testing and 13 items related to HPV self-sampling attitudes and beliefs were included in the survey. For both scales, the optimal number of factors was identified using Exploratory Factor Analysis (EFA) and parallel analysis. Item Response Theory (IRT) was applied within each factor to select items. Confirmatory Factor Analysis (CFA) was used to assess model fit. After data cleaning, 1027 responses were analyzed. The HPV Testing Attitudes and Beliefs Scale (HTABS) had four factors, and twenty-two items were retained after item reduction. The HPV Self-sampling Attitudes and Beliefs Scale (HSABS) had two factors and seven items were retained. CFA showed a good model fit for both final scales. The developed scales will be a valuable resource to examine attitudes and beliefs in anticipation of, and to evaluate, HPV test-based cervical screening.
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Affiliation(s)
- Ovidiu Tatar
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Research Center, Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
| | - Ben Haward
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Patricia Zhu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Samara Perez
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Cedars Cancer Centre, McGill University Health Centre (MUHC), Montreal, QC H4A 3J1, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
| | - Emily McBride
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Aisha K. Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Department of Family and Community Medicine, Women’s College Hospital, Toronto, ON M5S 1B3, Canada
| | | | - Marie-Hélène Mayrand
- Research Center, Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Ellen M. Daley
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Julia M. L. Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VI 3010, Australia
- Population Health, Australian Centre for the Prevention of Cervical Cancer, Melbourne, VI 3053, Australia
| | - Gregory D. Zimet
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
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Zhu Y, Hu Y, Shi J, Wei X, Song Y, Tang C, Zhang W. Plasma Thioredoxin Reductase as a Potential Biomarker for Gynecologic Cancer. Technol Cancer Res Treat 2023; 22:15330338231184995. [PMID: 37365925 DOI: 10.1177/15330338231184995] [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: 06/28/2023] Open
Abstract
BACKGROUND According to previous literatures, plasma thioredoxin reductase (TrxR) level was significantly elevated in various malignant tumors and serve as a potential biomarker for diagnosis and prognostic prediction. However, there is little awareness of the clinical value of plasma TrxR in gynecologic malignancies. In the present study, we aim to evaluate the diagnostic accuracy of plasma TrxR in gynecologic cancer and explore its role in treatment surveillance. METHODS We retrospectively enrolled 134 patients with gynecologic cancer and 79 patients with benign gynecologic disease. The difference of plasma TrxR activity and tumor markers level between two groups was compared using Mann-Whitney U test. By detecting pretreatment and post-treatment level of TrxR and conventional tumor markers, we further assessed the change trend of them with the Wilcoxon signed-ranks test. RESULTS Compared with benign control [5.7 (5, 6.6) U/mL], statistically significant increase of TrxR activity was observed in gynecologic cancer group [8.4 (7.25, 9.825) U/mL] (P < .0001), regardless of age and stage. On the basis of receiver operating characteristic (ROC) curves, we found plasma TrxR shows the highest diagnostic efficacy for distinguishing malignancy with benign disease, with an area under the curve (AUC) of 0.823 (95% confidence interval [CI] = 0.767-0.878), in the whole cohort. Besides, patients receiving treatment previously [8 (6.5, 9) U/mL] had a decreased TrxR level relative to treatment-native patients [9.9 (8.6, 10.85) U/mL]. Furthermore, follow-up data showed that plasma TrxR level would be evidently decreased after two courses of antitumor therapy (P < .0001), which is consistent with the downward trend of conventional tumor markers. CONCLUSION Collectively, all these results demonstrated plasma TrxR is an effective parameter for gynecologic cancer diagnosis and concurrently acts as a promising biomarker for treatment response assessment.
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Affiliation(s)
- Yinxing Zhu
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Yixuan Hu
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junfeng Shi
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaowei Wei
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yaqi Song
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Cuiju Tang
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wenwen Zhang
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Di Gennaro G, Licata F, Trovato A, Bianco A. Does self-sampling for human papilloma virus testing have the potential to increase cervical cancer screening? An updated meta-analysis of observational studies and randomized clinical trials. Front Public Health 2022; 10:1003461. [PMID: 36568753 PMCID: PMC9773849 DOI: 10.3389/fpubh.2022.1003461] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives A meta-analysis was conducted to examine the effectiveness of HPV self-sampling proposal on cervical cancer screening (CCS) uptake when compared with an invitation to have a clinician to collect the sample. Secondary outcomes were acceptability and preference of self-sampling compared to clinician-collected samples. Methods The present systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining the CCS uptake comparing self-sampling over invitation to be sampled by an healthcare professional and examining the proportion of women accepting or preferring self-sampling vs. clinician-collected sampling were included. The CCS uptake was also explored according to strategy of self-samplers' distribution, collection device type and screening status. Peters' test and Funnel Plot inspection were used to assess the publication bias. Quality of the studies was assessed through Cochrane Risk of Bias and NIH Quality Assessment tools. Results One hundred fifty-four studies were globally identified, and 482,271 women were involved. Self-sampling procedures nearly doubled the probability (RR: 1.8; 95% CI: 1.7-2.0) of CCS uptake when compared with clinician-collected samples. The opt-out (RR: 2.1; 95% CI: 1.9-2.4) and the door-to-door (RR: 1.8; 95% CI: 1.6-2.0) did not statistically significant differ (p = 1.177) in improving the CCS uptake. A higher relative uptake was shown for brushes (RR: 1.6; 95% CI: 1.5-1.7) and swabs (RR: 2.5; 95% CI: 1.9-3.1) over clinician-collected samples. A high between-studies variability in characteristics of sampled women was shown. In all meta-analyses the level of heterogeneity was consistently high (I 2 > 95%). Publication bias was unlikely. Conclusions Self-sampling has the potential to increase participation of under-screened women in the CCS, in addition to the standard invitation to have a clinician to collect the sample. For small communities door-to-door distribution could be preferred to distribute the self-sampler while; for large communities opt-out strategies should be preferred over opt-in. Since no significant difference in acceptability and preference of device type was demonstrated among women, and swabs and brushes exhibited a potential stronger effect in improving CCS, these devices could be adopted.
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Affiliation(s)
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
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HPV Testing Behaviors and Willingness to Use HPV Self-sampling at Home Among African American (AA) and Sub-Saharan African Immigrant (SAI) Women. J Racial Ethn Health Disparities 2022; 9:2485-2494. [PMID: 34780021 PMCID: PMC10060062 DOI: 10.1007/s40615-021-01184-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND HPV self-sampling is an emerging HPV testing method that offers reliable identification of cervical precancer and cancer. To determine the feasibility of HPV self-sampling in the USA, information is needed regarding women's use of HPV test and willingness to use self-sampling, especially among disparate groups such as African American (AA) and sub-Saharan African immigrant (SAI) women. The purpose of this study was to examine factors associated with having had at least one HPV test and willingness to use HPV self-sampling among AA and SAI women. METHODS AA and SAI women (n = 91) recruited from community settings completed a survey in a cross-sectional study. Data included sociodemographics, HPV and HPV testing knowledge, and willingness to use a HPV self-sampling test at home. Logistic regressions were performed to evaluate associations with having had a HPV test and willingness to use self-sampling. RESULTS Respondents mean age was 38.2 years (SD = 12.6) and 65% were SAIs. The majority (84%) reported having had at least one Pap test and (36%) had at least one HPV test. Sixty-seven percent were willing to self-sample at home. Age, education, and HPV testing knowledge were associated with having had a HPV test. Being uninsured and likelihood to accept a Pap test if recommended were associated with willingness to use self-sampling at home for an HPV test. CONCLUSIONS Health care providers have an important role in recommending cervical cancer screening according to current guidelines. HPV self-sampling may be a promising strategy to reach older, less educated, uninsured, and underinsured Black women.
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Wang WV, Kothari S, Skufca J, Giuliano AR, Sundström K, Nygård M, Koro C, Baay M, Verstraeten T, Luxembourg A, Saah AJ, Garland SM. Real-world impact and effectiveness of the quadrivalent HPV vaccine: an updated systematic literature review. Expert Rev Vaccines 2022; 21:1799-1817. [PMID: 36178094 DOI: 10.1080/14760584.2022.2129615] [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: 01/12/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) infection, which poses significant disease burden, is decreasing following implementation of vaccination programs. Synthesized evidence on HPV vaccine real-world benefit was published in 2016. However, long-term impact of vaccination, and how vaccination programs influence infection rates and disease outcomes, requires further examination. AREAS COVERED We systematically reviewed observational studies on HPV vaccination within MEDLINE, EMBASE, and Google Scholar from 2016 to 2020, involving 14 years of follow-up data. We identified 138 peer-reviewed publications reporting HPV vaccine impact or effectiveness. Outcomes of interest included rates of infection at different anatomical sites and incidence of several HPV-related disease endpoints. EXPERT OPINION The expansion of HPV vaccination programs worldwide has led to a reduction in genital infection and significant decreases in incidence of HPV-related disease outcomes. Therefore, the WHO has set goals for the elimination of cervical cancer as a public health concern. To track progress toward this requires an understanding of the effectiveness of different vaccination initiatives. However, the impact on males, and potential benefit of gender-neutral vaccination programs have not been fully explored. To present an accurate commentary on the current outlook of vaccination and to help shape policy therefore requires a systematic review of available data.
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Affiliation(s)
- Wei Vivian Wang
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Smita Kothari
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Jozica Skufca
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL USA
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Sweden
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Carol Koro
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Marc Baay
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | | | - Alain Luxembourg
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Alfred J Saah
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Suzanne M Garland
- Department of Obstetrics and Gynecology, The University of Melbourne, Royal Women's Hospital (RWH), Murdoch Childrens Research Institute, Melbourne, Australia
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