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Sokale IO, Thrift AP, Montealegre JR, Chido-Amajuoyi OG, Adekanmbi VT, Oluyomi AO. Using Geospatial Analysis to Identify Priority Communities for Cervical Cancer Prevention in Texas. AJPM FOCUS 2024; 3:100247. [PMID: 39034933 PMCID: PMC11260362 DOI: 10.1016/j.focus.2024.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Introduction Despite being almost entirely preventable, cervical cancer is the fourth most frequently diagnosed cancer among women worldwide. Cervical cancer incidence suggests missed opportunities for prevention. Geospatial analysis could strategically guide public health interventions. This study aimed to identify geographic clusters of cervical cancer incidence in Texas, a state with higher than national rates of cervical cancer incidence and mortality. Methods In this population-based cross-sectional study, the authors analyzed incident cervical cancer data among Texas women aged 30-64 years, from 2014 to 2018. The authors conducted a purely spatial Poisson-based analysis function in SaTScan to examine geographic clusters of higher-than-expected proportions of cervical cancer incidence (i.e., hot spots) and adjusted for age. Results A total of 5,060 women aged 30-64 years with incident cervical cancer diagnosis (mean age: 45.7 years, SD=9.6), including 1,840 (36.4%) Hispanic, 591 (11.7%) non-Hispanic Black, 2,397 (47.4%) non-Hispanic White, and 232 (4.6%) other races, were analyzed. Spatial scan analysis detected 7 significant hot spots of cervical cancer incidence. Hot spots were identified in the South Texas Plains (near Mexico border), Gulf Coast (Houston), Prairies and Lakes (North Texas), Panhandle Plains (Northwest Texas), and Piney Woods (Southeast Texas) regions of Texas. Hot spots, compared with the rest of Texas, had higher proportions of Hispanic population and individuals with socioeconomic disadvantages. Conclusions This study found spatial variation in cervical cancer incidence in Texas. The hot spot areas can benefit from targeted, novel, scalable, and cost-effective interventions to increase human papillomavirus vaccination and screening and early detection and treatment of precancerous cervical lesions.
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Affiliation(s)
- Itunu O. Sokale
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Aaron P. Thrift
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Jane R. Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Victor T. Adekanmbi
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Abiodun O. Oluyomi
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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Hoang TN, Berenson AB, Shan Y, Guo F, Adekanmbi V, Hsu C, Yu X, Kuo Y. Trends in HPV-associated cancer incidence in Texas medically underserved regions. Cancer Med 2024; 13:e70133. [PMID: 39190562 PMCID: PMC11348903 DOI: 10.1002/cam4.70133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/24/2024] [Accepted: 08/09/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND While cervical cancer incidence rates (IR) in the United States have dropped in the last 20 years, non-cervical human papillomavirus (HPV) associated cancers increased. Many people in Texas (TX) live in medically underserved areas and have higher risk of developing HPV-associated cancers. Since previous studies of these regions focused on cervical cancer, we included other HPV-associated cancers in our analysis of IR in East TX and the TX-Mexico Border compared to other TX regions. METHODS Cancer data from 2006 to 2019 were obtained from the TX Cancer Registry. Cases of HPV-associated cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers and corresponding patient-level demographic data were included. We calculated IR per 100,000 and drew heat maps to visualize cancer IR by county. To control potential confounders, we added county-level risk factors: rates for smoking, excessive drinking, obesity, STIs, primary care provider availability and dentist availability, from the County Health Rankings and Roadmaps program. We reported IRs by region and time and estimated unadjusted and adjusted risk ratio (RR) for association of each type of cancer and region. Lastly, we created adjusted models for each cancer by period to see time trends of regional differences. RESULTS Risk of anal, cervical, and oropharyngeal cancer was lower at parts of the Border than in the rest of TX in the adjusted model. We also observed increasing anal and oropharyngeal cancer risk and decreasing cervical and vaginal cancer risk over time. CONCLUSION Patient sociodemographics, behavioral risk factors, and access to care may contribute to some observed differences in cancer IR across regions. This indicates that targeted prevention efforts towards these regions, especially in low socioeconomic status communities, may benefit future generations.
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Affiliation(s)
- Thao N. Hoang
- Institute for Translational SciencesUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Abbey B. Berenson
- Center for Interdisciplinary Research in Women's HealthUniversity of Texas Medical BranchGalvestonTexasUSA
- Department of Obstetrics and GynecologyThe University of Texas Medical Branch at GalvestonGalvestonTexasUSA
| | - Yong Shan
- Department of Biostatistics and Data ScienceUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Fangjian Guo
- Center for Interdisciplinary Research in Women's HealthUniversity of Texas Medical BranchGalvestonTexasUSA
- Department of Obstetrics and GynecologyThe University of Texas Medical Branch at GalvestonGalvestonTexasUSA
| | - Victor Adekanmbi
- Center for Interdisciplinary Research in Women's HealthUniversity of Texas Medical BranchGalvestonTexasUSA
- Department of Obstetrics and GynecologyThe University of Texas Medical Branch at GalvestonGalvestonTexasUSA
| | - Christine Hsu
- Center for Interdisciplinary Research in Women's HealthUniversity of Texas Medical BranchGalvestonTexasUSA
- Department of Obstetrics and GynecologyThe University of Texas Medical Branch at GalvestonGalvestonTexasUSA
| | - Xiaoying Yu
- Department of Biostatistics and Data ScienceUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Yong‐Fang Kuo
- Department of Biostatistics and Data ScienceUniversity of Texas Medical BranchGalvestonTexasUSA
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Shastri SS, McNeill LH, Shete S. Culturally Competent Education and Human Papillomavirus Self-Sampling Achieves Healthy People 2030 Cervical Screening Target Among Low-Income Non-Hispanic Black and Hispanic Women. JCO Glob Oncol 2024; 10:e2400005. [PMID: 38723214 DOI: 10.1200/go.24.00005] [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: 01/07/2024] [Revised: 02/13/2024] [Accepted: 03/12/2024] [Indexed: 08/23/2024] Open
Abstract
PURPOSE Disparities in cervical cancer screening, incidence, and mortality exist in the United States. Cervical cancer incidence and mortality rates in Texas are 20% and 32% higher, respectively, than national averages. Within Texas, these rates are significantly higher among non-Hispanic (NH) Black and Hispanic women. Cervical cancer screening uptake is lower among NH Black and Hispanic women (72.9% and 75.9%, respectively) compared with White women (85.5%) in Texas. METHODS During March-August 2023, we conducted a pilot study that offered culturally competent education and human papillomavirus (HPV) self-sampling kits to women in two public housing projects in Houston, TX, that have predominantly NH Black or Hispanic residents. Among those eligible for cervical cancer screening, 35% (n = 24) of the NH Black and 34% (n = 16) of the Hispanic women were found to be underscreened per the US Preventive Services Task Force Guideline. We recruited 40 (24 NH Black and 16 Hispanic) eligible women for our study. The study was approved by the MD Anderson institutional review board and registered with ClinicalTrials.gov (NCT04614155-March 11, 2020). RESULTS Seventy-five percent of the NH Black and 87% of the Hispanic participants completed the HPV self-sampling procedures per protocol. Samples of 17% NH Black and 12% Hispanic participants showed a performance error. Overall, cervical cancer screening uptake improved from 65% to 91% among NH Black and from 66% to 96% among Hispanic participants. CONCLUSION Culturally competent education and HPV self-sampling resulted in remarkable improvement in cervical cancer screening uptake among underscreened NH Black and Hispanic women residents of Houston public housing projects. Implementing this strategy could significantly reduce cervical cancer incidence and mortality among similar populations in the United States and globally.
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Affiliation(s)
| | | | - Sanjay Shete
- University of Texas MD Anderson Cancer Center, Houston, TX
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Barquet-Muñoz SA, Arteaga-Gómez C, Díaz-López E, Rodríguez-Trejo A, Marquez-Acosta J, Aranda-Flores C. Current status and challenges in timely detection of cervical cancer in Mexico: expert consensus. Front Oncol 2024; 14:1383105. [PMID: 38606102 PMCID: PMC11007212 DOI: 10.3389/fonc.2024.1383105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Cervical cancer is a significant public health problem in low- and middle-income countries, accounting for 85% of new cases worldwide. Due to poorly organized screening programs, cervical cancer is more likely to develop in vulnerable groups who do not initiate or rarely undergo screening. Cervical cytology and detecting high-risk human papillomavirus types are the recommended screening tools. Further, these strategies allow for accurately identifying women at a higher risk of cervical cancer and establishing screening times. New detection tools, such as novel biomarkers or automatic HPV detection in the vagina or urine, can improve screening coverage. This review aims to identify the challenges faced by detection programs and screening tools in Mexico to provide evidence-based recommendations to improve early detection programs for cervical cancer.
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Affiliation(s)
| | | | - Elsa Díaz-López
- Colegio Mexicano de Especialistas en Ginecología y Obstetricia, Mexico City, Mexico
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Varon ML, Geng Y, Fellman BM, Troisi C, Fernandez ME, Li R, Reininger B, Schmeler KM, Allanson E. Interventions to increase follow-up of abnormal cervical cancer screening results: A systematic literature review and meta-analysis. PLoS One 2024; 19:e0291931. [PMID: 38381754 PMCID: PMC10880967 DOI: 10.1371/journal.pone.0291931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/10/2023] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Ensuring timely follow-up of abnormal screening results is essential for eliminating cervical cancer. OBJECTIVE The purpose of the study was to review single and multicomponent interventions designed to improve follow-up of women with abnormal cervical cancer screening results. We report on effectiveness across studies, and describe what aspects of these interventions might be more impactful. METHODS Publications were searched between January 2000 and December 2022. The search included observational, quasi-experimental (pre-post studies) and randomized controlled studies describing at least one intervention to increase follow-up of women with abnormal cervical cancer screening results. Outcomes of studies included completion of any follow-up (i.e., attending a follow-up appointment), timely diagnosis (i.e., colposcopy results within 90 days of screening) and time to diagnostic resolution (i.e., days between screening and final diagnosis). We assessed risk of bias for observational and quasi-experimental studies using the Newcastle-Ottawa Scale (NOS) tool and the Cochrane collaboration tool for randomized studies. We conducted a meta-analysis using studies where data were provided to estimate a summary average effect of the interventions on follow-up of patients and to identify characteristics of studies associated with an increased effectiveness of interventions. We extracted the comparison and intervention proportions of women with follow-up before and after the intervention (control and intervention) and plotted the odds ratios (ORs) of completing follow-up along with the 95% confidence intervals (CIs) using forest plots for the interventions vs. controls when data were available. FINDINGS From 7,457 identified studies, 28 met the inclusion criteria. Eleven (39%) of the included studies had used a randomized design. Most studies (63%) assessed completion of any follow-up visit as the primary outcome, whereas others measured time to definite diagnosis (15%) or diagnostic resolution (22%). Navigation was used as a type of intervention in 63% of the included studies. Most interventions utilized behavioral approaches to improve outcomes. The overall estimate of the OR for completion of follow-up for all interventions was 1.81 (1.36-2.42). The highest impact was for programs using more than one approach (multicomponent interventions) to improve outcomes with OR = 3.01 (2.03-4.46), compared with studies with single intervention approaches with OR = 1.56 (1.14-2.14). No statistical risks were noted from publication bias or small-study effects in the studies reviewed. CONCLUSION Our findings revealed large heterogeneity in how follow-up of abnormal cervical cancer screening results was defined. Our results suggest that multicomponent interventions were more effective than single component interventions and should be used to improve follow-up after abnormal cervical cancer screening results. Navigation appears to be an important tool for improving follow-up. We also provide recommendations for future studies and implications for policy in terms of better defining outcomes for these interventions.
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Affiliation(s)
- Melissa Lopez Varon
- Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Bryan M. Fellman
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Catherine Troisi
- Management, Policy & Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Maria E. Fernandez
- Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Ruosha Li
- Biostatistics, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Belinda Reininger
- Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Brownsville Regional Campus, Brownsville, Texas, United States of America
| | - Kathleen M. Schmeler
- Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Emma Allanson
- The Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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Varon M, Salcedo MP, Fellman B, Troisi C, Gowen R, Daheri M, Rodriguez AM, Toscano P, Guerra L, Gasca M, Cavazos B, Marin E, Fisher-Hoch S, Fernandez ME, Reininger B, Ruosha L, Baker E, Schmeler K. A Comprehensive Program to Improve Treatment of Precancerous Cervical Lesions in the Rio Grande Valley of Texas. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:89-98. [PMID: 37350621 DOI: 10.1097/phh.0000000000001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To assess the impact of a multicomponent intervention in women with cervical dysplasia who were treated with loop electrosurgical excision procedure (LEEP), as well as the time between colposcopy and treatment. DESIGN Retrospective cohort study. INTERVENTION Clinic participation in a multicomponent cervical cancer prevention program that included community outreach, patient in-reach, and navigation, as well as provider capacity building with in-person training and ongoing telementoring through Project ECHO. MAIN OUTCOME MEASURES Medical records were reviewed to evaluate women with cervical dysplasia undergoing treatment with LEEP within 90 days of colposcopy, as well as time between colposcopy and treatment. Baseline data from year 1 were compared with each subsequent year of implementation. Additional variables examined included patient's age, history of abnormal screening results, and percentage of families living below poverty line based on county of residence, parity, and clinic site. We performed logistic regression and multiple linear regression analyses to assess the programmatic impact in the outcomes of interest by year of program implementation. RESULTS A total of 290 women were included in the study. The proportion of women undergoing treatment within 90 days of colposcopy increased from 76.2% at baseline to 91.3% in year 3 and 92.9% in year 4 of program implementation. The odds of undergoing treatment within 90 days were 5.11 times higher in year 4 of program implementation than at baseline. The mean time between colposcopy and LEEP decreased from 62 days at baseline to 45 days by year 4 of program implementation. CONCLUSIONS Implementation of our multicomponent cervical cancer prevention program increased the proportion of women undergoing LEEP within 90 days of colposcopy and decreased the time between colposcopy and LEEP. This program has the potential to support cervical cancer prevention efforts and could be implemented in other low-resource settings.
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Affiliation(s)
- Melissa Varon
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Drs Varon, Salcedo, Baker, and Schmeler, and Mr Fellman); The University of Texas Health Science Center, School of Public Health, Houston, Texas (Drs Troisi, Fernandez, and Ruosha); The University of Texas Health Science Center, School of Public Health Brownsville Regional Campus, Brownsville, Texas (Ms Gasca, Drs Gowen, Fisher-Hoch, and Reininger); Harris Health, Houston, Texas (Ms Daheri); The University of Texas Medical Branch, Houston, Texas (Dr Rodriguez); McGovern Medical School, Houston, Texas (Mr Toscano) Su Clinica, Harlingen, Texas (Mss Guerra and Cavazos, and Dr Marin)
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Batman SH, Varon ML, Daheri M, Ogburn T, Rivas SD, Guerra L, Toscano PA, Gasca M, Campos L, Foster S, Martin M, Yvette Williams-Brown M, Poindexter Y, Reininger B, Salcedo MP, Milbourne A, Fellman B, Fernandez ME, Baker E, Gowen R, Fisher-Hoch S, Rodriguez AM, Milan J, Pippin M, Hawk E, Schmeler KM. Addressing cervical cancer disparities in Texas: Expansion of a community-based prevention initiative for medically underserved populations. Prev Med Rep 2023; 36:102486. [PMID: 38021412 PMCID: PMC10660094 DOI: 10.1016/j.pmedr.2023.102486] [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: 07/24/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Although cervical cancer is preventable, significant disparities exist in access to screening and prevention services. In medically underserved areas (MUAs) of Texas, these rates are 55% higher compared to the remainder of the US. In 2019, we expanded a multicomponent, comprehensive program to improve cervical cancer prevention in partnership with 13 clinics and mobile vans in MUAs of Texas. Our multicomponent intervention program consists of community education and patient navigation coupled with a training/mentoring program for local medical providers to perform diagnostic procedures and treatment for patients with abnormal screening results. Hands-on training courses to learn these skills are coupled with biweekly telementoring conferences using Project ECHO® (Extension for Community Healthcare Outcomes). This program was implemented in 2015 and expanded to other MUAs in Texas in 2019. From March 2019 to August 2022, 75,842 individuals were educated about cervical cancer screening and HPV vaccination. A total of 44,781 women underwent screening for cervical cancer, and 2,216 underwent colposcopy and 264 underwent LEEP. High-grade cervical dysplasia was diagnosed in 658 individuals and invasive cervical cancer in 33 individuals. We trained 22 providers to perform colposcopy and/or LEEP. In addition, 78 Project ECHO telementoring sessions were held with an average of 42 attendees per session, with 72 individual patient cases discussed. Our comprehensive community-based prevention initiative for medically underserved populations has led to a significant number of individuals undergoing cervical cancer screening in MUAs, as well as improved access to colposcopy and LEEP services.
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Affiliation(s)
| | - Melissa L Varon
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maria Daheri
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Tony Ogburn
- The University of Texas Rio Grande Valley Medical School, Edinburg, TX
| | - Saul D Rivas
- The University of Texas Rio Grande Valley Medical School, Edinburg, TX
| | | | - Paul A Toscano
- The University of Texas Health McGovern Medical School, Houston, TX
| | - Monica Gasca
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Lori Campos
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Savanah Foster
- The University of Texas Health Science Center at Tyler, Tyler, TX
| | | | | | | | - Belinda Reininger
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Mila P Salcedo
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Bryan Fellman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maria E Fernandez
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Ellen Baker
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Susan Fisher-Hoch
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | | | - Jessica Milan
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Monica Pippin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ernest Hawk
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Bolarinwa OA, Holt N. Barriers to breast and cervical cancer screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom: evidence from a mixed-methods systematic review. BMC Health Serv Res 2023; 23:390. [PMID: 37087506 PMCID: PMC10122823 DOI: 10.1186/s12913-023-09410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Cancer is currently the leading cause of mortality globally, with new cancer cases estimated at 19.3 million and almost 10 million deaths in 2020. Specifically, breast and cervical cancer incidence and mortality prevalence among women of the minority group or marginalised populations in Europe have continued to be a public health concern due to the low uptake of cancer screening. Thus, this study utilised a mixed-method systematic review to identify barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom. METHODS Databases including PubMed, CINAHL, British Nursing Index, Web of Science, EMBASE, and Scopus databases, were systematically searched for studies on barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom published in English between January 2010 to July 2022. This mixed-method systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in reporting the included studies' results. The cluster mapping approach was used to identify and classify the barriers into themes. RESULTS Thirteen eligible studies were included in this current review. Seven of the thirteen studies used quantitative cross-sectional research design, while six used qualitative cross-sectional research design. These studies were conducted across the United Kingdom. Five themes were developed from the cluster mapping, and thirty-four sub-theme barriers to the uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom were identified. The developed themes in relation to the barriers include; socio-demographic characteristics, health service delivery, cultural, religious & language, the gap in knowledge & awareness, and emotional, sexual & family support. CONCLUSION The study concluded that barriers in socio-demographic characteristics, health service delivery, cultural, religious and language, the gap in knowledge & awareness, and emotional, sexual & family support were identified as non-uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom. Reducing or eliminating these barriers would improve the benefits of timely breast and cervical cancer screening in the United Kingdom.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health & Well-Being, Faculty of Health & Social Care, University of Chester, Chester, UK.
- Institute for Advanced Studies in the Humanities, University of Edinburgh, Edinburgh, UK.
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
- Department of Allied and Public Health, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK.
| | - Nicole Holt
- Department of Allied and Public Health, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
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9
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Castellanos MI, Oluyomi AO, Chambers TM, Gramatges MM, Winestone LE, Lupo PJ, Scheurer ME. Ethnic disparities in childhood leukemia survival by border residence: A Texas population-based analysis. Cancer 2023; 129:1276-1286. [PMID: 36805949 DOI: 10.1002/cncr.34636] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND The US-Mexico border is a medically underserved region where survival disparities have been observed in adults diagnosed and treated for various malignancies. Studies examining survival disparities among children living in this region and diagnosed with cancer are lacking. The objective of this study was to evaluate the impact of border residence on survival among children with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and living near the Texas-Mexico border at the time of their diagnosis. The authors hypothesized that this group experiences inferior survival compared with patients with childhood leukemia living in nonborder areas. METHODS The authors conducted a retrospective survival analysis leveraging data from the Texas Cancer Registry. The study included patients aged birth to 19 years who were diagnosed with ALL or AML between 1995 and 2017. Cox proportional hazards models were used to evaluate the factors associated with the risk of death. Overall survival estimates were calculated using Kaplan-Meier methods. RESULTS During the study period, there were 6002 children diagnosed with ALL and 1279 diagnosed with AML. Inferior 5-year overall survival was observed among children with ALL living along the border region compared with those living in nonborder areas (77.5% vs. 85.8%). In adjusted models, children with ALL living along the border experienced a 30% increased hazard of death versus children living in nonborder areas. In contrast, for children with AML, survival estimates did not vary by border versus nonborder residence. CONCLUSIONS Living along the border was associated with inferior survival among children with ALL, but not among children with AML. Additional studies are urgently needed to identify the factors driving these disparities to effectively design multilevel interventions and influence state and national cancer control programs.
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Affiliation(s)
- Maria I Castellanos
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Abiodun O Oluyomi
- Department of Medicine, Epidemiology, and Population Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tiffany M Chambers
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Maria M Gramatges
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lena E Winestone
- Division of Allergy, Immunology, and Blood and Marrow Transplant, University of California-San Francisco Benioff Children's Hospitals, San Francisco, California, USA
| | - Philip J Lupo
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Michael E Scheurer
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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10
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Falk D, Cubbin C, Salsman JM, Winkfield KM, Foley KL, Noel L, Jones B. Navigating Financial Barriers to Papanicolaou Tests and Mammograms for Young Adult Women Residing in Rural and Border Areas of Texas. J Adolesc Young Adult Oncol 2023; 12:159-167. [PMID: 35475705 PMCID: PMC10124170 DOI: 10.1089/jayao.2022.0013] [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: 11/13/2022] Open
Abstract
Purpose: Costs of Papanicolaou (Pap) tests and mammograms are a primary barrier for women aged 18-39 seeking screening and diagnostic services. Race/ethnicity and rural/border resident status compound their risks for delayed diagnosis, possibly resulting in higher mortality. Methods: We analyzed cross-sectional data from young adult (YA) women (aged 18-39) from a cancer education and patient navigation (PN) program in rural and border Texas from 2012 to 2016. Descriptive statistics, Chi-square tests, and logistic regressions summarized sociodemographic variables and receipt of PN, Pap tests, and mammograms. Results: The sample consisted of 1181 women aged 31.8 years (standard deviation 5.5) on average. A total of 795 (67.3%) received PN, 494 (41.8%) received a Pap test, and 121 (10.3%) received a mammogram. The YA women attending the program due to cost (odds ratio [OR]: 7.24; confidence interval [CI]: 4.74-11.05) and reporting 1 (OR: 3.84; CI: 2.40-6.14) or 2+ barriers (OR: 6.00; CI: 3.61-9.99) had higher odds of being navigated than those not concerned about cost and not identifying a barrier. The YA women attending due to cost (OR: 2.22, CI: 1.61-3.05) and receiving navigation (OR: 1.92; CI: 1.29-2.84) had higher odds of receiving a Pap test than their counterparts. The majority receiving a mammogram were worried about cost (85.1%); 40.5% had a family history of breast cancer, and a doctor or nurse recommended a mammogram for 15.7%. Conclusion: Detection of cervical and breast cancer in YA women residing in rural and border Texas may be improved with PN to assist with financial barriers to care and service coordination.
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Affiliation(s)
- Derek Falk
- Department of Social Sciences and Health Policy and Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - John M. Salsman
- Department of Social Sciences and Health Policy and Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Karen M. Winkfield
- Meharry-Vanderbilt Alliance, Nashville, Tennessee, USA
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristie L. Foley
- Department of Social Sciences and Health Policy and Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Lailea Noel
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Barbara Jones
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
- Departments of Health Social Work, Oncology, Population Health, and Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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11
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Salcedo MP, Gowen R, Rodriguez AM, Fisher-Hoch S, Daheri M, Guerra L, Toscano PA, Gasca M, Morales J, Reyna-Rodriguez FE, Cavazos B, Marin E, Perez C, Guerra M, Milbourne A, Varon ML, Reininger B, Fernandez ME, Ogburn T, Castle PE, McCormick J, Baker E, Hawk E, Schmeler KM. Addressing high cervical cancer rates in the Rio Grande Valley along the Texas-Mexico border: a community-based initiative focused on education, patient navigation, and medical provider training/telementoring. Perspect Public Health 2023; 143:22-28. [PMID: 34130548 DOI: 10.1177/1757913921994610] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIMS Cervical cancer incidence and mortality rates are approximately 55% higher in the Rio Grande Valley (RGV) along the Texas-Mexico border compared with the average rates in the US. Our aim was to improve cervical cancer prevention efforts in the RGV through a comprehensive multilevel intervention initiative focused on community education, patient navigation, and training of local providers. METHODS We initiated a program in the RGV which consisted of (1) community education, (2) patient navigation, and (3) a training/mentoring program for local medical providers including hands-on training courses coupled with telementoring using Project ECHO® (Extension for Community Health Outcomes). We assessed the number of women undergoing cervical cancer screening, diagnosis, and treatment at three participating clinics caring for underserved women in the region. RESULTS From November 2014 to October 2018, 14,846 women underwent cervical cancer screening. A total of 2030 (13.7%) women underwent colposcopy for abnormal results (179% increase over baseline) and 453 women underwent loop electrosurgical excision procedures (LEEPs) for treatment of cervical dysplasia. Invasive cancer was diagnosed in 39 women who were navigated to a gynecologic oncologist for treatment. Seven local medical providers were trained to perform colposcopy and/or LEEP. Project ECHO telementoring videoconferences were held every 2 weeks for a total 101 sessions with an average of 22 participants per session and a total of 180 patient cases presented and discussed. CONCLUSIONS Our program led to a large number of women undergoing diagnosis and treatment of cervical dysplasia in the RGV. If sustained, we anticipate these efforts will decrease cervical cancer rates in the region. The program is currently being expanded to additional underserved areas of Texas and globally to low- and middle-income countries.
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Affiliation(s)
- M P Salcedo
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Federal University of Health Sciences of Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - R Gowen
- Su Clínica, Brownsville, TX, USA
| | - A M Rodriguez
- The University of Texas Medical Branch, Galveston, TX, USA
| | - S Fisher-Hoch
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - M Daheri
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - L Guerra
- Su Clínica, Brownsville, TX, USA
| | - P A Toscano
- UTHealth McGovern Medical School, Houston, TX, USA
| | - M Gasca
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - J Morales
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | | | | | - E Marin
- Su Clínica, Brownsville, TX, USA
| | - C Perez
- Su Clínica, Brownsville, TX, USA
| | - M Guerra
- The University of Texas Medical Branch, Galveston, TX, USA
| | - A Milbourne
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M L Varon
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Reininger
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - M E Fernandez
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - T Ogburn
- The University of Texas Rio Grande Valley Medical School, Edinburg, TX, USA
| | - P E Castle
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - J McCormick
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E Baker
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Hawk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Unit 1362, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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12
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Etling MA, Vik TA, Janota AD, Liang KL, Kryder‐Reid CL, Robertson M, Scanlon C, Carson A, Agley J, Severance TS. The continuing evolution of a cancer prevention, screening, and survivorship
ECHO
: A second year of implementation. Cancer Med 2022; 12:7398-7405. [PMID: 36504440 PMCID: PMC10067045 DOI: 10.1002/cam4.5441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION An estimated 39,010 Indiana residents were diagnosed with cancer in 2021. To address the cancer burden, Project ECHO (Extension Community Healthcare Outcomes) was launched in 2019 in Indiana to build specialty healthcare capacity among non-specialists. Due to positive outcomes from the pilot year, the Cancer Prevention, Screening, and Survivorship ECHO was implemented for a second year. The purpose of this study was to measure the participation and regional impact of this ECHO. METHODS ECHO sessions occurred twice monthly from October 2020 to October 2021. Changes were implemented in response to feedback from the pilot year, including making the curriculum more practical for learners and adding accreditation opportunities. Participant information and feedback was extracted from electronic surveys for review. RESULTS There were 24 ECHO sessions with 213 unique participants, increased from 140 unique participants in the pilot year. An average of 23.5 individuals attended each session, increased from 15.5 individuals per session. Enrolled participants served in a diverse set of roles and represented 247 zip codes, 30 Indiana counties, and 32 states across the United States, each of which increased from the pilot year. DISCUSSION In this second year, this ECHO expanded to reach more participants with increased attendance and a more diverse distribution of roles within healthcare, which may be attributed to feedback-driven curriculum design. Cancer care is multi-disciplinary, with health educators, nurses, and administrators, each acting within the cancer care continuum. As a result, this ECHO has been adapted to serve an increasingly broad distribution of professionals. CONCLUSION The second year of the Cancer Prevention, Screening, and Survivorship ECHO displayed increased overall enrollment and participation, greater diversity among participant roles, and a wider reach across Indiana and the United States.
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Affiliation(s)
- Mary Ann Etling
- Indiana University School of Medicine Indianapolis Indiana USA
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | - Terry A. Vik
- Indiana University School of Medicine Indianapolis Indiana USA
- Riley Hospital for Children Indianapolis Indiana USA
- Riley Hospital Division of Pediatric Hematology Oncology Indianapolis Indiana USA
| | - Andrea D. Janota
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | - Kaley L. Liang
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | | | - Mary Robertson
- Indiana Cancer Consortium Indianapolis Indiana USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center Indianapolis Indiana USA
| | | | - Anyé Carson
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | - Jon Agley
- Indiana University School of Public Health Bloomington Indiana USA
- Prevention Insights Bloomington Indiana USA
| | - Tyler S. Severance
- Indiana University School of Medicine Indianapolis Indiana USA
- Riley Hospital for Children Indianapolis Indiana USA
- Riley Hospital Division of Pediatric Hematology Oncology Indianapolis Indiana USA
- Department of Child Health University of Missouri School of Medicine Columbia Missouri USA
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13
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Falk D, Cubbin C, Jones B. County-Level Poverty and Barriers to Breast and Cervical Cancer Screening in a Health Education and Patient Navigation Program for Rural and Border Texas Residents. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:421-429. [PMID: 32696337 PMCID: PMC7855227 DOI: 10.1007/s13187-020-01832-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The study examined the impact of (1) county-level poverty rates and (2) patient navigation on breast and cervical cancer screening outcomes for women in rural and border counties in Texas reporting barriers to screening.Univariate analyses described the distribution and screening prevalence rates in the sample, while a series of random intercept logistic regression models analyzed mammogram (N = 2326 women aged 40+) and Papanicolaou (Pap; N = 2959 women aged 21-64) screening separately.Mammogram and Pap screening prevalence rates were highest among women who were aged 40-64, Spanish-speaking Latinas, lower educated, attending cancer education events because of the cost of the screenings, patient navigation recipients, living in the south region of Texas, and in counties with high poverty. Although models indicated significant variability in screening rates by county, county-level poverty was only significantly associated with odds of getting Pap screening in adjusted models. Not receiving patient navigation vs. receiving it was associated with lower odds for both mammogram (OR: 0.51, CI: 0.38-0.70) and Pap (OR: 0.69, CI: 0.50-0.94) screenings.County-level variation in screening rates exists for both mammogram and Pap tests and should be considered in the development and implementation of screening interventions in rural and border areas. However, other factors beyond poverty levels may explain the variation.
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Affiliation(s)
- Derek Falk
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, 1 University Station D3500, Austin, TX, 78712, USA
| | - Barbara Jones
- Steve Hicks School of Social Work, The University of Texas at Austin, 1 University Station D3500, Austin, TX, 78712, USA
- Departments of Health Social Work, Oncology, Population Health, and Psychiatry, Dell Medical School, The University of Texas at Austin, 1 University Station D3500, Austin, TX, 78712, USA
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14
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Kayser K, Washington A, Anderson G, Harris LM, Lee HY, LaJoie AS. Perceived Barriers and Facilitators in Accessing Cervical Cancer Screening: The Voices of Women in a Low-Income Urban Community. FAMILY & COMMUNITY HEALTH 2022; 45:46-57. [PMID: 34783690 DOI: 10.1097/fch.0000000000000312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although advancements in cervical cancer prevention have helped reduce the incidence, mortality, and prevalence, access to these preventive services has not been experienced equally by all women in the United States. The purpose of this study was to learn about the factors that affect access to preventive services in a low-income, primarily Black community. Using a community-based participatory research approach, women were recruited to participate in 7 focus groups, with 6 to 8 women per group (N = 45). Participants were mainly Black (64%), with a mean age of 46 years, and 60% reporting completing at least some college. The discussions were transcribed, and text data were organized using Dedoose software. Guided by qualitative content analysis, the data were analyzed through an iterative process of coding and condensing the codes into themes. Ten types of barriers and 11 facilitators relating to cervical cancer screening access were identified and grouped into 7 themes. Participants provided suggestions for promoting cervical cancer screening in their community. On the basis of the findings of the data, the researchers conceptualized and mapped culturally and geographically appropriate interventions to promote cervical cancer screening within the community of interest.
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Affiliation(s)
- Karen Kayser
- Kent School of Social Work (Drs Kayser, Washington, Harris, and Anderson) and School of Public Health and Information Sciences (Dr LaJoie), University of Louisville, Louisville, Kentucky; and School of Social Work, The University of Alabama, Tuscaloosa (Dr Lee)
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15
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Severance TS, Milgrom Z, Carson A, Scanlon CM, Chauhan O'Brien R, Anderson B, Robertson M, Janota A, Coven SL, Mendonca EA, Duwve J, Vik TA. Cancer prevention, screening, and survivorship ECHO: A pilot experience with an educational telehealth program. Cancer Med 2021; 11:238-244. [PMID: 34816614 PMCID: PMC8704156 DOI: 10.1002/cam4.4421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction The American Cancer Society, Inc. (ACS) estimates that 37,940 Indiana residents were diagnosed with cancer in 2020, which remains the leading cause of death in the state. Across the cancer continuum, national goals have been established targeting recommended benchmarks for states in prevention, screening, treatment, and survivorship. Indiana consistently falls below most goals for each of these targeted categories. Methods To address these disparities, we implemented Project ECHO (Extension for Community Healthcare Outcomes) as a virtual telehealth educational platform targeted at local healthcare providers. ECHO programs utilize a novel tele‐mentoring approach to the education of clinicians in a hub/spoke design. Sessions occurred twice monthly from September 2019 to September 2020 and consisted of a traditional didactic lecture and a case‐based discussion led by participating providers. Results During the pilot year there were a total of 22 ECHO sessions with 140 different participants. On average, 15.5 spokes attended each session with increasing participation at the end of the year. Post‐session surveys suggested generally favorable perception with 72% of respondents finding the quality “excellent.” Discussion Given the increasing rate of recurrent participation toward the end of the pilot year in conjunction with the favorable survey responses following each session, it was felt that the program was overall successful and warranted continued implementation. Conclusion The Project ECHO platform is a validated telehealth education platform that has the potential to impact cancer care at multiple points along the cancer continuum at the regional level.
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Affiliation(s)
- Tyler S Severance
- Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | - Zheng Milgrom
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Anyé Carson
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | | | | | - Brent Anderson
- Indiana State Department of Health, Indianapolis, Indiana, USA
| | | | - Andrea Janota
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Scott L Coven
- Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | - Eneida A Mendonca
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Joan Duwve
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Terry A Vik
- Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA.,Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
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16
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Cudjoe J, Budhathoki C, Roter D, Gallo JJ, Sharps P, Han HR. Exploring Health Literacy and the Correlates of Pap Testing Among African Immigrant Women: Findings from the AfroPap Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:441-451. [PMID: 32410109 PMCID: PMC7666038 DOI: 10.1007/s13187-020-01755-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
African immigrant (AI) women have low rates of Pap testing. Health literacy plays a pivotal role in health behaviors. Sources and types of health information could shape health literacy and inform the Pap testing behaviors of AI women. However, the influences of health literacy, sources, and types of health information along with cultural and psychosocial correlates on the Pap testing behaviors of AI women are poorly understood. To examine how sources and types of health information impact health literacy, and in turn, how health literacy and cultural and psychosocial factors influence the Pap testing behaviors of AI women. An adapted Health Literacy Skills Framework guided the selection of variables for this cross-sectional study. Convenience sampling was used to recruit 167 AI women, 21-65 years. Multivariate logistic regression was used to assess correlates of Pap testing after adjusting for covariates (age, education, English proficiency, employment, income, health insurance, access to primary care, marital status, and healthcare provider recommendation). Most participants (71%) had received a Pap test in the past and used multiple (two or more) sources (65%) and types (57%) of health information. Using multiple sources of health information (aOR 0.11, p < 0.01) but not types of health information was associated with Pap testing. Having negative cultural beliefs (aOR 0.17, p = 0.01) and having high self-efficacy (aOR 9.38, p < 0.01) were significantly associated with Pap testing after adjusting for covariates. High health literacy (OR 3.23, p < 0.05) and high decisional balance (OR 5.28, p < 0.001) were associated with Pap testing in bivariate models but did not remain significant after controlling for covariates. Cultural beliefs was a significant correlate of AI women's Pap testing behaviors regardless of other known social determinants of health (education, English proficiency, age, access to primary care). Disseminating health information through various sources has the potential to promote Pap testing among AI women. Larger studies which utilize a robust sampling strategy and include a diverse group of AI women are needed in order to optimize health interventions aimed at improving Pap test screening behaviors among AI women.
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Affiliation(s)
- Joycelyn Cudjoe
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA.
- Inova Health System, 8110 Gatehouse Road Suite 200W, Falls Church, VA, 22042, USA.
| | - Chakra Budhathoki
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Debra Roter
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Joseph J Gallo
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Phyllis Sharps
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Hae-Ra Han
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA
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17
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Cudjoe J, Gallo JJ, Sharps P, Budhathoki C, Roter D, Han HR. The Role of Sources and Types of Health Information in Shaping Health Literacy in Cervical Cancer Screening Among African Immigrant Women: A Mixed-Methods Study. Health Lit Res Pract 2021; 5:e96-e108. [PMID: 34251922 PMCID: PMC8244574 DOI: 10.3928/24748307-20210322-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health literacy is a strong determinant of health outcomes among immigrants. How sources and types of health information influence health literacy in the context of cervical cancer screening among African immigrant women remains unknown. OBJECTIVE This study was undertaken to explore how various sources and types of health information influence information sharing and health literacy in the context of cervical cancer screening among African immigrant women. METHODS Using a mixed-methods approach, a convenience sample of African immigrant women (N = 167) completed study surveys followed by semi-structured individual phone interviews with a purposive sub-sample (n = 20) of survey participants. The relationship between sources and types of health information and health literacy was assessed using multivariate logistic regression. Emergent themes were identified in the qualitative interviews using content analysis. Qualitative and quantitative data were merged to describe differences and similarities in African immigrant women's experiences and display of health literacy by different sources and types of health information. KEY RESULTS Health care providers (78%), women friends (46%), and internet (45%) were the most common sources of health information used by African immigrant women, followed by women relatives (32%), television (22%), social media (17%), and church (16%). Content analysis revealed that the health care provider was rated as the most credible source; personal experiences of family and friends made health information more relatable; and church was the least endorsed source. Health information presented verbally (adjusted odds ratio of 5.51, p = .01) was associated with higher health literacy even after controlling for covariates. Most African immigrant women had health information presented in verbal form (80%), with pictures (43%) being the least popular type of health information. CONCLUSIONS Study findings suggest that verbal communication is associated with health literacy in the context of cervical cancer screening among African immigrant women. Health interventions that use peer educators (women friends and family) and incorporate verbal communication may be a more effective strategy in promoting positive cervical cancer health behaviors among African immigrant women. [HLRP: Health Literacy Research and Practice. 2021;5(2):e96-e108.] Plain Language Summary: For this mixed-methods study, a convenience sample of African immigrant women (N = 167) completed study surveys followed by semi-structured individual phone interviews with a purposive sub-sample (n = 20) of the survey participants. Study findings show a strong association between verbal communication and health literacy in the context of cervical cancer screening among African immigrant women.
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Biddell CB, Spees LP, Smith JS, Brewer NT, Des Marais AC, Sanusi BO, Hudgens MG, Barclay L, Jackson S, Kent EE, Wheeler SB. Perceived Financial Barriers to Cervical Cancer Screening and Associated Cost Burden Among Low-Income, Under-Screened Women. J Womens Health (Larchmt) 2021; 30:1243-1252. [PMID: 33851854 DOI: 10.1089/jwh.2020.8807] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Despite screening's effectiveness in reducing cervical cancer incidence and mortality, disparities in cervical cancer screening uptake remain, with lower rates documented among uninsured and low-income individuals. We examined perceived financial barriers to, and the perceived cost burden of, cervical cancer screening. Materials and Methods: We surveyed 702 low-income, uninsured or publicly insured women ages 25-64 years in North Carolina, U.S., who were not up to date on cervical cancer screening according to national guidelines. Participants were asked about perceived financial barriers to screening and how much they perceived screening would cost. We used multivariable logistic regression to assess the sociodemographic predictors of perceived financial barriers. Results: Seventy-two percent of participants perceived financial barriers to screening. Screening appointment costs (71%) and follow-up/future treatment costs (44%) were most commonly reported, followed by lost pay due to time missed from work (6%) and transportation costs (5%). In multivariable analysis, being uninsured (vs. publicly insured), younger (25-34 vs. 50-64 years), White (vs. Black), and not reporting income data were associated with perceiving screening costs and future treatment costs as barriers to screening. Participants reported wide-ranging estimates of the perceived out-of-pocket cost of screening ($0-$1300), with a median expected cost of $245. Conclusions: The majority of our sample of low-income women perceived substantial financial barriers to screening, particularly related to screening appointment costs and potential follow-up/future treatment costs. Providing greater cost transparency and access to financial assistance may reduce perceived financial barriers to screening, potentially increasing screening uptake among this underserved population. Clinicaltrials.gov registration number NCT02651883.
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Affiliation(s)
- Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer S Smith
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Health Behavior and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrea C Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Busola O Sanusi
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael G Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lynn Barclay
- American Sexual Health Association, Research Triangle Park, North Carolina, USA
| | - Sarah Jackson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Fuzzell LN, Perkins RB, Christy SM, Lake PW, Vadaparampil ST. Cervical cancer screening in the United States: Challenges and potential solutions for underscreened groups. Prev Med 2021; 144:106400. [PMID: 33388330 DOI: 10.1016/j.ypmed.2020.106400] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/09/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
Cervical cancer screening rates in the United States are generally high, yet certain groups demonstrate disparities in screening and surveillance. Individuals at greatest risk for cervical cancer are often from marginalized or underserved groups who do not participate in regular screening for a variety of reasons. Using the Population-based Research to Optimize the Screening Process (PROSPR) Trans-Organ Conceptual Model, including concepts of individual-, provider-, facility-, system-, or policy-level factors, we provide a commentary to highlight reasons for low screening participation among subgroups in the U.S. These include racial and ethnic minorities, rural residents, sexual and gender minorities, those with limited English proficiency, those with particular religious beliefs, and various health conditions. We describe barriers and offer potential solutions for each group. In addition, we discuss cross-cutting barriers to screening including difficulty interacting with the healthcare system (limited knowledge and health literacy, lack of provider recommendation/contact), financial (cost, lack of insurance), and logistical barriers (e.g., lack of usual source of care, competing demands, scheduling issues). Solutions to address these barriers are needed to improve screening rates across all underscreened groups. Changes at state and national policy levels are needed to address health insurance coverage. Mobile screening, ensuring that interpreters are available for all visits, and targeted in reach at non-gynecological visits can further overcome barriers. Employing community outreach workers can increase community demand for screening, and patient navigators can improve adherence to both screening and follow-up diagnostic evaluation. HPV self-sampling can address multiple barriers to cervical cancer screening.
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Affiliation(s)
- Lindsay N Fuzzell
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America.
| | - Rebecca B Perkins
- Boston University School of Medicine, 85 E. Concord St., Boston, MA 02118, United States of America
| | - Shannon M Christy
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America
| | - Paige W Lake
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America
| | - Susan T Vadaparampil
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America.
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20
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Ngwa W, Olver I, Schmeler KM. The Use of Health-Related Technology to Reduce the Gap Between Developed and Undeveloped Regions Around the Globe. Am Soc Clin Oncol Educ Book 2020; 40:1-10. [PMID: 32223667 DOI: 10.1200/edbk_288613] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cancer is the second leading cause of death worldwide, with approximately 70% of the 9.6 million deaths per year occurring in low- and middle-income countries (LMICs), where there is critical shortage of human and material resources or infrastructure to deal with cancer. If the current trend continues, the burden of cancer is expected to increase to 22 million new cases annually by 2030, with 81% of new cases and almost 88% of mortality occurring in LMICs. Global health places a priority on improving health and reducing these disparities to achieve equity in health for all people worldwide. In today's hyper-connected world, information and communication technologies (ICTs) will increasingly play an integral role in global health. Here, we focus on how the use of health-related technology, specifically ICTs and artificial intelligence (AI), can help in closing the gap between high-income countries (HICs) and LMICs in cancer care, research, and education. Key examples are highlighted on the use of telemedicine and tumor boards, as well as other online resources that can be leveraged to advance global health.
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Affiliation(s)
- Wilfred Ngwa
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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21
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Barriers and Facilitators of Pap Testing for Women Living With HIV: A Focus Group Study. J Assoc Nurses AIDS Care 2020; 31:190-196. [PMID: 31567730 DOI: 10.1097/jnc.0000000000000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Yang M, Li L, Jiang C, Qin X, Zhou M, Mao X, Xing H. Co-infection with trichomonas vaginalis increases the risk of cervical intraepithelial neoplasia grade 2-3 among HPV16 positive female: a large population-based study. BMC Infect Dis 2020; 20:642. [PMID: 32873233 PMCID: PMC7466445 DOI: 10.1186/s12879-020-05349-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
Background Evidence suggested that vaginal microbiome played a functional role in the progression of cervical lesions in female infected by HPV. This study aimed at evaluating the influence of common vaginal infection on the carcinogenicity of high risk HPV (hr-HPV). Methods From January 15, 2017 to December 31, 2017, 310,545 female aged at least 30 years old had been recruited for cervical cancer screening from 9 clinical research centers in Central China. All the recruited participants received hr-HPV genotyping for cervical cancer screening and vaginal microenvironment test by a high vaginal swab. Colposcopy-directed biopsy was recommended for female who were infected with HPV 16 and HPV 18, and other positive hr-HPV types through test had undertaken triage using liquid-based cytology, cases with the results ≥ ASCUS among them were referred to colposcopy directly, and cervical tissues were taken for pathology examination to make clear the presence or absence of other cervical lesions. Results Among 310,545 female, 6067 (1.95%) were tested with positive HPV 16 and HPV 18, 18,297 (5.89%) were tested with other positive hr-HPV genotypes, cervical intraepithelial neoplasia (CIN) 1, CIN 2, CIN 3 and invasive cervical cancer (ICC) were detected in 861 cases, 377 cases, 423 cases, and 77 cases, respectively. Candida albicans and Gardnerella were not associated with the detection of cervical lesions. Positive trichomonas vaginitis (TV) was correlated with hr-HPV infection (p < 0.0001). Co-infection with TV increased the risk of CIN 1 among female infected with hr-HPV (OR 1.18, 95% CI: 1.42–2.31). Co-infection with TV increased the risk of CIN 2–3 among female infected with HPV 16 (OR 1.71, 95% CI: 1.16–2.53). Conclusions Co-infection of TV and HPV 16 is a significant factor for the detection of cervical lesions.
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Affiliation(s)
- Mei Yang
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Lin Li
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Chunfan Jiang
- Department of Pathology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Xiaomin Qin
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Min Zhou
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Xiaogang Mao
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Hui Xing
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China.
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23
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Zhou Q, Xie Y, Wang L, Xu T, Gao Y. LncRNA EWSAT1 upregulates CPEB4 via miR-330-5p to promote cervical cancer development. Mol Cell Biochem 2020; 471:177-188. [PMID: 32556917 DOI: 10.1007/s11010-020-03778-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022]
Abstract
Long non-coding RNA (lncRNA) Ewing sarcoma associated transcript 1 (EWSAT1) is an oncogene in a variety of tumors. Here, we planned to demonstrate EWSAT1 function in cervical cancer and further illustrate its underlying mechanism. EWSAT1 expression in cervical cancer was evaluated through qRT-PCR. Colony forming capacity was measured by colony formation assay and cell proliferation ability was measured by CCK-8 kit. Wound healing experiment was applied to test the cell migration and transwell assay was applied to test the invasion ability. Luciferase assay was employed to demonstrate EWSAT1 and miR-330-5p interaction. In cervical cancer, the expression of EWSAT1 was enhanced and contributed to the poor prognosis. Downregulated EWSAT1 expression inhibited Hela cell migration, proliferation, and invasion. EWSAT1 targeted to miR-330-5p and upregulated cytoplasmic polyadenylation element-binding protein 4 (CPEB4) expression by sponging miR-330-5p. Our study revealed that EWSAT1 enhances CPEB4 expression through sponging miR-330-5p, thereby promoting cervical cancer development, which might provide potential therapeutic targets for clinically cervical cancer patients.
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Affiliation(s)
- Qingyan Zhou
- Department of Gynecology, Dongchangfu District, Liaocheng Dongchangfu People's Hospital, No. 128 Songgui Road, Liaocheng, 252000, Shandong, China.
| | - Yuan Xie
- Department of Gynecology, Dongchangfu District, Liaocheng Dongchangfu People's Hospital, No. 128 Songgui Road, Liaocheng, 252000, Shandong, China
| | - Li Wang
- Department of Gynecology, Dongchangfu District, Liaocheng Dongchangfu People's Hospital, No. 128 Songgui Road, Liaocheng, 252000, Shandong, China
| | - Tao Xu
- Delivery Room, Dongchangfu District, Liaocheng Dongchangfu People's Hospital, No. 128 Songgui Road, Liaocheng, 252000, Shandong, China
| | - Yongbin Gao
- Department of Gynecology, Dongchangfu District, Liaocheng Dongchangfu People's Hospital, No. 128 Songgui Road, Liaocheng, 252000, Shandong, China
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24
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Zhao D, Zhang H, Long J, Li M. LncRNA SNHG7 Functions as an Oncogene in Cervical Cancer by Sponging miR-485-5p to Modulate JUND Expression. Onco Targets Ther 2020; 13:1677-1689. [PMID: 32161467 PMCID: PMC7049860 DOI: 10.2147/ott.s237802] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/03/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Long non-coding RNA (LncRNA) SNHG7 is involved in the development of multiple cancers. However, its role in cervical cancer (CC) has not been elucidated. This study aimed to explore the function of SNHG7 in CC progression and the underlying mechanisms. MATERIALS AND METHODS The expression levels of SNHG7 and miR-485-5p in CC tissues and cell lines were measured by qPCR. Functional experiments including CCK-8 assay, wound healing assay, transwell assay, flow cytometry, Western blot, luciferases reporter assay and immunoprecipitation (RIP) were performed to explore the SNHG7/miR-485-5p/JUND pathway. Additionally, in vivo study was carried out by establishing tumor xenograft models. RESULTS We found that SNHG7 was markedly enhanced in CC tissues and cell lines, and associated with poor clinical characteristics. In vitro, knockdown of SNHG7 inhibited CC cell proliferation, migration and invasion, as well as aggravated cell apoptosis. As to mechanism investigation, rescue experiments revealed that miR-485-5p inhibitor could partially reverse the effects on CC cells induced by SNHG7 knockdown. SNHG7 upregulated JUND expression via miR-485-5p. Moreover, tumor xenograft models were established to confirm the findings in vivo. CONCLUSION SNHG7 promoted CC progression through miR-485-5p/JUND axis. The SNHG7/miR-485-5p/JUND pathway might provide a novel therapeutic target for CC treatment.
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Affiliation(s)
- Danyang Zhao
- Department of Reproductive Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, People’s Republic of China
| | - Hui Zhang
- Department of Obstetrics, Chongzuo People’s Hospital, Chongzuo, Guangxi Province, People’s Republic of China
| | - Jianxiong Long
- School of Public Health of Guangxi Medical University, Nanning, Guangxi Province, People’s Republic of China
| | - Mujun Li
- Department of Reproductive Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, People’s Republic of China
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Tang Y, Kortum A, Parra SG, Vohra I, Milbourne A, Ramalingam P, Toscano PA, Schmeler KM, Richards-Kortum RR. In vivo imaging of cervical precancer using a low-cost and easy-to-use confocal microendoscope. BIOMEDICAL OPTICS EXPRESS 2020; 11:269-280. [PMID: 32010516 PMCID: PMC6968771 DOI: 10.1364/boe.381064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 05/08/2023]
Abstract
Cervical cancer incidence and mortality rates remain high in medically underserved areas. In this study, we present a low-cost (<$5,000), portable and user-friendly confocal microendoscope, and we report on its clinical use to image precancerous lesions in the cervix. The confocal microendoscope employs digital apertures on a digital light projector and a CMOS sensor to implement line-scanning confocal imaging. Leveraging its versatile programmability, we describe an automated aperture alignment algorithm to ensure clinical ease-of-use and to facilitate technology dissemination in low-resource settings. Imaging performance is then evaluated in ex vivo and in vivo pilot studies; results demonstrate that the confocal microendoscope can enhance visualization of nuclear morphology, contributing to significantly improved recognition of clinically important features for detection of cervical precancer.
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Affiliation(s)
- Yubo Tang
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
- The authors contributed equally to this work
| | - Alex Kortum
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
- The authors contributed equally to this work
| | - Sonia G. Parra
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Imran Vohra
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Andrea Milbourne
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX 77057, USA
| | - Preetha Ramalingam
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX 77030, USA
| | - Paul A. Toscano
- The University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX 78520, USA
| | - Kathleen M. Schmeler
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX 77057, USA
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Cudjoe J, Turkson-Ocran RA, Ezeigwe AK, Commodore-Mensah Y, Nkimbeng M, Han HR. Recruiting African Immigrant Women for Community-Based Cancer Prevention Studies: Lessons Learned from the AfroPap Study. J Community Health 2019; 44:1019-1026. [PMID: 31102117 PMCID: PMC6708449 DOI: 10.1007/s10900-019-00677-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recruitment in research can be challenging, particularly for racial/ethnic minorities and immigrants. There remains a dearth of research identifying the health and sociocultural needs of these populations related to recruitment. To describe our experiences and lessons learned in recruiting African immigrant (AI) women for the AfroPap study, a community-based study examining correlates of cervical cancer screening behaviors. We developed several recruitment strategies in collaboration with key informants and considered published recruitment methods proven effective in immigrant populations. We also evaluated the various recruitment strategies using recruitment records and study team meeting logs. We enrolled 167 AI women in the AfroPap study. We used the following recruitment strategies: (1) mobilizing African churches; (2) utilizing word of mouth through family and friends; (3) maximizing research team's cultural competence and gender concordance; (4) promoting altruism through health education; (5) ensuring confidentiality through the consenting and data collection processes; and (6) providing options for data collection. Online recruitment via WhatsApp was an effective recruitment strategy because it built on existing information sharing norms within the community. Fear of confidentiality breaches and time constraints were the most common barriers to recruitment. We were successful in recruiting a "hard-to-reach" immigrant population in a study to understand the correlates of cervical cancer screening behaviors among AI women by using a variety of recruitment strategies. For future research involving African immigrants, using the internet and social media to recruit participants is a promising strategy to consider.
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Affiliation(s)
- Joycelyn Cudjoe
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Ruth-Alma Turkson-Ocran
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Angelica K Ezeigwe
- School of Medicine, The Johns Hopkins University, 733 N. Broadway, Baltimore, MD, 21205, USA
| | - Yvonne Commodore-Mensah
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Center for Cardiovascular and Chronic Care, The Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Manka Nkimbeng
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Hae-Ra Han
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Center for Cardiovascular and Chronic Care, The Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Center for Community Innovation and Scholarship, The Johns Hopkins School of Nursing, 855 N Wolfe Street, Baltimore, MD, 21205, USA
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Kundrod KA, Smith CA, Hunt B, Schwarz RA, Schmeler K, Richards-Kortum R. Advances in technologies for cervical cancer detection in low-resource settings. Expert Rev Mol Diagn 2019; 19:695-714. [PMID: 31368827 DOI: 10.1080/14737159.2019.1648213] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Cervical cancer mortality rates remain high in low- and middle-income countries (LMICs) and other medically underserved areas due to challenges with implementation and sustainability of routine screening, accurate diagnosis, and early treatment of preinvasive lesions. Areas covered: In this review, we first discuss the standard of care for cervical cancer screening and diagnosis in high- and low-resource settings, biomarkers that correlate to cervical precancer and cancer, and needs for new tests. We review technologies for screening and diagnosis with a focus on tests that are already in use in LMICs or have the potential to be adapted for use in LMICs. Finally, we provide perspectives on the next five years of technology development for improved cervical cancer screening and diagnosis in LMICs. Expert opinion: Innovation toward improved molecular and imaging tests is needed to enable effective, affordable see-and-treat approaches to detect and treat cervical precancer in a single visit. Current molecular tests remain too complex and/or costly for widespread use. Especially with imaging tests, decision support may improve performance of new technologies.
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Affiliation(s)
| | - Chelsey A Smith
- Department of Bioengineering, Rice University , Houston , TX , USA
| | - Brady Hunt
- Department of Bioengineering, Rice University , Houston , TX , USA
| | | | - Kathleen Schmeler
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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