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Garcia K, Iacob E, Dean-Smith M, Royce E, Alvarez G, Kepka D. Low Levels of Lifetime Pap Test Receipt Among Vulnerable Guatemalans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:264-270. [PMID: 38376746 DOI: 10.1007/s13187-024-02405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
Low and middle-income countries, such as Guatemala, shoulder a disproportionate share of cervical cancer, a preventable disease in high income countries. Tangible obstacles, such as lack of access to health care, cultural differences, and insufficient infrastructure, and facilitators, such as being Ladino, married, and educated, have been identified in the literature related to cervical cancer prevention. The aim of this survey was to explore barriers and facilitators to cervical cancer prevention, comparing rural Indigenous and urban Ladino populations. We surveyed 139 women in two health clinics. Participants answered questions about demographic information, cervical cancer knowledge, and health care behaviors. We analyzed survey data with four bivariate models. Our results suggest vulnerable populations, such as rural Indigenous women who are single, illiterate, and lack education, face higher cervical cancer risk. Partnerships should be formed with health promotors and lay midwives to educate and encourage vulnerable populations to prevent cervical cancer.
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Affiliation(s)
- Kimberly Garcia
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT, 84112, USA.
| | - Eli Iacob
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT, 84112, USA
| | - Mari Dean-Smith
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT, 84112, USA
| | - Emily Royce
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT, 84112, USA
| | | | - Deanna Kepka
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT, 84112, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, USA
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Vega-Crespo B, Neira VA, Maldonado - Rengel R, López D, Delgado-López D, Guerra Astudillo G, Verhoeven V. "Barriers and Advantages of Self-Sampling Tests, for HPV Diagnosis: A Qualitative Field Experience Before Implementation in a Rural Community in Ecuador". Int J Womens Health 2024; 16:947-960. [PMID: 38827925 PMCID: PMC11143988 DOI: 10.2147/ijwh.s455118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/10/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Cervical cancer screening has demonstrated high efficacy in reducing cervical cancer mortality worldwide. However, clinician sampling is often perceived as an uncomfortable procedure that could reduce screening uptake. Self-sampling methods for HPV diagnosis have shown high sensitivity, which could increase acceptance and screening rates among women. Purpose This study aims to identify the perceived barriers and advantages of self-sampling methods versus clinician sampling for cervical cancer screening in a rural setting in Ecuador. Patients and Methods A qualitative study was conducted. Seven focus group discussions took place in the rural Parish of El Valle in Azuay Province, Cuenca, Ecuador. Women native to this rural area were included in the study. FGDs were recorded and transcribed, and content analysis was performed to categorize and analyze the data. Results A total of 45 women participated in the study. Clinician sampling was perceived as a painful and intrusive method. However, participants believed that it is more reliable compared to self-sampling methods, attributing this to the direct visualization of the cervix, which facilitates the detection of cervical pathologies. The perceived advantages of self-sampling included increased comfort, pain reduction, time savings, the ability to perform the test at home, and the potential for widespread availability through pharmacies or local traditional healers. Nevertheless, doubts about the test's reliability as well as the user's proficiency in self-testing posed barriers to the adoption of this technique. Conclusion Self-sampling methods offer several advantages over clinician sampling, such as enhanced privacy, comfort, and accessibility to cancer screening. Barriers primarily revolved around users' proficiency in performing the test and the reliability of the results. Providing training for using self-sampling tests could address these barriers.
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Affiliation(s)
| | - Vivian Alejandra Neira
- Departamento de Biociencias, Facultad de Ciencias Químicas, Universidad de Cuenca, Cuenca, Ecuador
- Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador
| | | | - Diana López
- Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador
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Hill SK, Bempong-Ahun N, Okolo ID, Lalla AT, Worku D, Asres T, Philpotts L, Fallah PN, Varallo J, Corlew S, Kamfwa P, Parham GP, Hicks ML, Ibbotson G, Randall T. Improving access to safe, quality surgical care for gynecologic cancers through capacity-building interventions in low- and middle-income countries: A scoping review. Int J Gynaecol Obstet 2024; 165:552-561. [PMID: 37927080 DOI: 10.1002/ijgo.15156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/16/2023] [Accepted: 09/10/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Following the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low- and middle-income countries (LMICs). A well-integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task-sharing and training of gynecologic oncologists (GynOncs). OBJECTIVES This review aimed to explore existing literature on capacity-building for surgical management of early-stage gynecologic cancers. SEARCH STRATEGY The search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE. SELECTION CRITERIA Studies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task-sharing, or outcomes following operation by subspecialists compared to specialists were included. DATA COLLECTION AND ANALYSIS Results were synthesized using narrative synthesis approach with emergence of key themes by frequency. MAIN RESULTS The scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non-subspecialized care, and task-shifting/-sharing. CONCLUSIONS A multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity-building and task-sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost-effectiveness.
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Affiliation(s)
- Sarah K Hill
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Isioma Dianne Okolo
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amber Trujillo Lalla
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dawit Worku
- Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - Tadios Asres
- Department of Obstetrics and Gynecology, Rwanda Military Hospital (RMH), Kigali, Rwanda
| | - Lisa Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Parisa N Fallah
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John Varallo
- The Global Surgery Foundation, Geneva, Switzerland
| | - Scott Corlew
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Kamfwa
- Department of Gynecologic Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Groesbeck P Parham
- Women and Newborn Hospital-University Teaching Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Michael L Hicks
- Women and Newborn Hospital-University Teaching Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Gynecologic Oncology, Michigan Cancer Institute, St. Joseph Mercy Oakland, Pontiac, USA
| | - Geoffrey Ibbotson
- The Global Surgery Foundation, Geneva, Switzerland
- United Nations Institute for Training and Research, Geneva, Switzerland
| | - Thomas Randall
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
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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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Shin MB, Oluoch LM, Barnabas RV, Baynes C, Fridah H, Heitner J, Kerubo MB, Ngure K, Pinder LF, Thomas KK, Mugo NR, Gimbel S. Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services: a protocol for a stepped-wedge cluster randomized trial in Kenya. Implement Sci 2023; 18:26. [PMID: 37365575 PMCID: PMC10294443 DOI: 10.1186/s13012-023-01282-3] [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: 03/10/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND An important cervical cancer prevention strategy in low- and middle-income countries (LMICs) has been single-visit screen-and-treat (SV-SAT) approach, using visual inspection with acetic acid (VIA) and ablative treatment with cryotherapy to manage precancerous lesions. While SV-SAT with VIA and cryotherapy have established efficacy, its population level coverage and impact on reducing cervical cancer burden remains low. In Kenya, the estimated cervical cancer screening uptake among women aged 30-49 is 16% and up to 70% of screen-positive women do not receive treatment. Thermal ablation for treatment of precancerous lesions of the cervix is recommended by the World Health Organization and has the potential to overcome logistical challenges associated with cryotherapy and facilitate implementation of SV-SAT approach and increase treatment rates of screen-positive women. In this 5-year prospective, stepped-wedge randomized trial, we plan to implement and evaluate the SV-SAT approach using VIA and thermal ablation in ten reproductive health clinics in central Kenya. METHODS The study aims to develop and evaluate implementation strategies to inform the national scale-up of SV-SAT approach with VIA and thermal ablation through three aims: (1) develop locally tailored implementation strategies using multi-level participatory method with key stakeholders (patient, provider, system-level), (2) implement SV-SAT approach with VIA and thermal ablation and evaluate clinical and implementation outcomes, and (3) assess the budget impact of SV-SAT approach with VIA and thermal ablation compared to single-visit, screen-and-treat method using cryotherapy. DISCUSSION Our findings will inform national scale-up of the SV-SAT approach with VIA and thermal ablation. We anticipate that this intervention, along with tailored implementation strategies will enhance the adoption and sustainability of cervical cancer screening and treatment compared to the standard of care using cryotherapy. TRIAL REGISTRATION NCT05472311.
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Affiliation(s)
- Michelle B Shin
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | | | - Ruanne V Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Colin Baynes
- Department of Global Health, University of Washington, Seattle, USA
| | - Harriet Fridah
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Jesse Heitner
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Leeya F Pinder
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Nelly Rwamba Mugo
- Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, USA
| | - Sarah Gimbel
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, USA
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Cruz-Valdez A, Palacio-Mejía LS, Quezada-Sánchez AD, Hernández-Ávila JE, Galicia-Carmona T, Cetina-Pérez LDC, Arango-Bravo EA, Isla-Ortiz D, Aranda-Flores CE, Uscanga-Sánchez SR, Madrid-Marina V, Torres-Poveda K. Cervical cancer prevention program in Mexico disrupted due to COVID-19 pandemic: Challenges and opportunities. Front Oncol 2023; 13:1008560. [PMID: 36969022 PMCID: PMC10034019 DOI: 10.3389/fonc.2023.1008560] [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: 08/01/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction The COVID-19 pandemic disrupted the preventive services for cervical cancer (CC) control programs in Mexico, which will result in increased mortality. This study aims to assess the impact of the pandemic on the interruption of three preventive actions in the CC prevention program in Mexico. Methods This study is a retrospective time series analysis based on administrative records for the uninsured population served by the Mexican Ministry of Health. Patient data were retrieved from the outpatient service information system and the hospital discharge database for the period 2017-2021. Data were aggregated by month, distinguishing a pre-pandemic and a pandemic period, considering April 2020 as the start date of the pandemic. A Poisson time series analysis was used to model seasonal and secular trends. Five process indicators were selected to assess the disruption of the CC program, these were analyzed as monthly data (N=39 pre-pandemic, N=21 during the pandemic). HPV vaccination indicators (number of doses and coverage) and diagnostic characteristics of CC cases were analyzed descriptively. The time elapsed between diagnosis and treatment initiation in CC cases was modeled using restricted cubic splines from robust regression. Results Annual HPV vaccination coverage declined dramatically after 2019 and was almost null in 2021. The number of positive Papanicolaou smears decreased by 67.8% (90%CI: -72.3, -61.7) in April-December 2020, compared to their expected values without the pandemic. The immediate pandemic shock (April 2020) in the number of first-time and recurrent colposcopies was -80.5% (95%CI:-83.5, -77.0) and -77.9% (95%CI: -81.0, -74.4), respectively. An increasing trend was observed in the proportion of advanced stage and metastatic CC cases. The fraction of CC cases that did not receive medical treatment or surgery increased, as well as CC cases that received late treatment after diagnosis. Conclusions Our analyses show significant impact of the COVID-19 pandemic with declines at all levels of CC prevention and increasing inequalities. The restarting of the preventive programs against CC in Mexico offers an opportunity to put in place actions to reduce the disparities in the burden of disease between socioeconomic levels.
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Affiliation(s)
- Aurelio Cruz-Valdez
- Center for Population Health Research, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | - Lina Sofia Palacio-Mejía
- Consejo Nacional de Ciencia y Tecnología (CONACYT)—Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | - Amado D. Quezada-Sánchez
- Center for Evaluation and Surveys Research, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | | | - Tatiana Galicia-Carmona
- Department of Clinical Research and Medical Oncology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico
| | | | - Eder A. Arango-Bravo
- Department of Clinical Research and Medical Oncology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico
| | - David Isla-Ortiz
- Department of Oncology Gynecology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico
| | | | | | - Vicente Madrid-Marina
- Chronic Infections and Cancer Division, Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | - Kirvis Torres-Poveda
- Consejo Nacional de Ciencia y Tecnología (CONACYT)—Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
- Chronic Infections and Cancer Division, Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
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Vega Crespo B, Neira VA, Ortíz Segarra J, Andrade A, Guerra G, Ortiz S, Flores A, Mora L, Verhoeven V, Gama A, Dias S, Verberckmoes B, Vermandere H, Michelsen K, Degomme O. Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals. BMC Public Health 2022; 22:2144. [DOI: 10.1186/s12889-022-14601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Cervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer.
Methodology
A qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data.
Results
Overall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient–physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women’s empowerment.
Conclusions
The women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screening.
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Vega Crespo B, Neira VA, Ortíz S J, Maldonado-Rengel R, López D, Gómez A, Vicuña MJ, Mejía J, Benoy I, Carreño TP, Verhoeven V. Evaluation of Urine and Vaginal Self-Sampling versus Clinician-Based Sampling for Cervical Cancer Screening: A Field Comparison of the Acceptability of Three Sampling Tests in a Rural Community of Cuenca, Ecuador. Healthcare (Basel) 2022; 10:healthcare10091614. [PMID: 36141226 PMCID: PMC9498379 DOI: 10.3390/healthcare10091614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67–52.8), and urine sampling, OR 16.63 (6.79–40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44–18.93), and urine sampling, OR 19.5 (5.83–65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03–0.16), and urine sampling, OR 0.01 (0–0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07–0.34), and urine sampling, OR 0.05 (0.01–0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71–9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods.
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Affiliation(s)
- Bernardo Vega Crespo
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca 010203, Ecuador
- Correspondence:
| | - Vivian Alejandra Neira
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca 010203, Ecuador
- Facultad de Medicina, Universidad del Azuay UDA, Cuenca 010104, Ecuador
| | - José Ortíz S
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca 010203, Ecuador
| | - Ruth Maldonado-Rengel
- Facultad de Ciencias de la Salud, Universidad Técnica Particular de Loja UTPL Loja Ecuador, Loja 1101608, Ecuador
- Programa de Doctorado en Ciencias Morfológicas, Universidad de La Frontera UFRO, Temuco 4811230, Chile
| | - Diana López
- Facultad de Medicina, Universidad del Azuay UDA, Cuenca 010104, Ecuador
| | - Andrea Gómez
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca 010203, Ecuador
| | - María José Vicuña
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca 010203, Ecuador
| | - Jorge Mejía
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca 010203, Ecuador
| | - Ina Benoy
- AMBIOR, Laboratory for Cell Biology and Histology, University of Antwerp, 2610 Antwerp, Belgium
| | - Tesifón Parrón Carreño
- Facultad de Ciencias de la Salud y Neurociencias, Universidad de Almería UAL, 04120 Almería, Spain
| | - Veronique Verhoeven
- Family Medicine and Population Health, University of Antwerp, 2610 Antwerp, Belgium
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Torres KL, Rondon HHDMF, Martins TR, Martins S, Ribeiro A, Raiol T, Marques CP, Corrêa F, Migowski A, Minuzzi-Souza TTCE, Schiffman M, Rodriguez AC, Gage JC. Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city-Lessons learned from the Amazon city of Manaus, Brazil. PLoS One 2021; 16:e0258539. [PMID: 34662368 PMCID: PMC8523067 DOI: 10.1371/journal.pone.0258539] [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] [Received: 04/01/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
The World Health Organization Call to Eliminate Cervical Cancer resonates in cities like Manaus, Brazil, where the burden is among the world's highest. Manaus has offered free cytology-based screening since 1990 and HPV immunization since 2013, but the public system is constrained by many challenges and performance is not well-defined. We obtained cervical cancer prevention activities within Manaus public health records for 2019 to evaluate immunization and screening coverage, screening by region and neighborhood, and the annual Pink October screening campaign. We estimated that among girls and boys age 14-18, 85.9% and 64.9% had 1+ doses of HPV vaccine, higher than rates for age 9-13 (73.4% and 43.3%, respectively). Of the 90,209 cytology tests performed, 24.9% were outside the target age and the remaining 72,230 corresponded to 40.1% of the target population (one-third of women age 25-64). The East zone had highest screening coverage (49.1%), highest high-grade cytology rate (2.5%) and lowest estimated cancers (38.1/100,000) compared with the South zone (32.9%, 1.8% and 48.5/100,000, respectively). Largest neighborhoods had fewer per capita screening locations, resulting in lower coverage. During October, some clinics successfully achieved higher screening volumes and high-grade cytology rates (up to 15.4%). Although we found evidence of some follow-up within 10 months post-screening for 51/70 women (72.9%) with high-grade or worse cytology, only 18 had complete work-up confirmed. Manaus has successfully initiated HPV vaccination, forecasting substantial cervical cancer reductions by 2050. With concerted efforts during campaigns, some clinics improved screening coverage and reached high-risk women. Screening campaigns in community locations in high-risk neighborhoods using self-collected HPV testing can achieve widespread coverage. Simplifying triage and treatment with fewer visits closer to communities would greatly improve follow-up and program effectiveness. Achieving WHO Cervical Cancer Elimination goals in high-burden cities will require major reforms for screening and simpler follow-up and treatment.
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Affiliation(s)
- Kátia Luz Torres
- Amazon State Oncology Control Foundation (FCECON), Manaus, Amazonas, Brazil
- Post Graduation Program in Health Sciences and Basic and Applied Immunology at The Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
| | - Heidy Halanna de Melo Farah Rondon
- Post Graduation Program in Health Sciences and Basic and Applied Immunology at The Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
| | - Toni Ricardo Martins
- Tropical Medicine Institute, São Paulo University, Virology Laboratory (LIM52) (USP-SP) - São Paulo, São Paulo, Brazil
| | - Sandro Martins
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
| | - Ana Ribeiro
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
- Department of Pharmacy, Faculty of Health Sciences, University of Brasília (UNB), Brasília, Federal District, Brazil
| | - Taina Raiol
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
| | - Carla Pintas Marques
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
- Collective Health, Universidade de Brasília (UnB), Brasília, Federal District, Brazil
| | - Flavia Corrêa
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arn Migowski
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thais Tâmara Castro e Minuzzi-Souza
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
- National Immunization Program, Health Surveillance Secretariat (SVS), Ministry of Health, Brasília, Federal District, Brazil
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, United States of America
| | - Ana Cecilia Rodriguez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, United States of America
| | - Julia C. Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, United States of America
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10
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Vidhubala E, Niraimathi K, Shewade HD, Mahadevan S. Cervical Cancer Care Continuum in South India: Evidence from a Community-based Screening Program. J Epidemiol Glob Health 2021; 10:28-35. [PMID: 32175707 PMCID: PMC7310805 DOI: 10.2991/jegh.k.191111.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 07/24/2019] [Indexed: 11/01/2022] Open
Abstract
In India, cervical cancer screening is conducted at various levels; however, after screening, the adherence to the cancer care continuum is barely understood. This study evaluated a community-based cancer screening program conducted in a rural setting (Tirunelveli and Tuticorin districts) in South India and reviewed the completion of care continuum. In this longitudinal descriptive study involving secondary data collection, data from the case records of 2192 women who were consecutively screened between March 2015 and May 2016 were included. All women underwent conventional cytology-based screening (Pap smear) and Visual Inspection with Acetic Acid (VIA). Those for whom either test was positive were referred for histopathological confirmation. Patients with confirmed precancerous conditions and unsatisfactory Pap smears were referred for further management. In total, 2192 women were screened [age range, 17-69 years; mean (standard deviation), 39.2 (8.5)]. Common symptom and sign were white discharge per vaginum (34.9%) and cervical erosion (34.4%), respectively. The VIA was positive for 24% (523/2178; 14 women did not cooperate for VIA) and 113 (5.1%) had epithelial cell abnormality in the Pap smear test. Per histopathology findings, one woman had non-keratinizing squamous cell carcinoma. Seven, three, and four had cervical intraepithelial neoplasia I, II and III, respectively. Of 2192, 807 were eligible for referral (597 had positive results on either Pap or VIA). Among the 807 women referred, only 74 (9.2%) women visited the referral center. The follow-up rate was very poor accounting to fragmentation of care continuum. The success of the screening program depends on the completion of the care continuum.
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Affiliation(s)
- E Vidhubala
- Nellai Cancer Care Center, Udhavum Ullangal, Tirunelveli, Tamil Nadu, India.,Fenivi Research Solutions, Chennai, Tamil Nadu, India
| | - K Niraimathi
- Fenivi Research Solutions, Chennai, Tamil Nadu, India
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi, India.,Karuna Trust, Bengaluru, Karnataka, India
| | - Sankar Mahadevan
- Nellai Cancer Care Center, Udhavum Ullangal, Tirunelveli, Tamil Nadu, India
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11
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Dykstra M, Malone B, Lekuntwane O, Efstathiou J, Letsatsi V, Elmore S, Castro C, Tapela N, Dryden-Peterson S. Impact of Community-Based Clinical Breast Examinations in Botswana. JCO Glob Oncol 2021; 7:17-26. [PMID: 33405960 PMCID: PMC8081526 DOI: 10.1200/go.20.00231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We evaluated a clinical breast examination (CBE) screening program to determine the prevalence of breast abnormalities, number examined per cancer diagnosis, and clinical resources required for these diagnoses in a middle-income African setting. METHODS We performed a retrospective review of a CBE screening program (2015-2018) by Journey of Hope Botswana, a Botswana-based nongovernmental organization (NGO). Symptomatic and asymptomatic women were invited to attend. Screening events were held in communities throughout rural and periurban Botswana, with CBEs performed by volunteer nurses. Individuals who screened positive were referred to a private tertiary facility and were followed by the NGO. Data were obtained from NGO records. RESULTS Of 6,120 screened women (50 men excluded), 452 (7.4%) presented with a symptom and 357 (5.83%) were referred for further evaluation; 257 ultrasounds, 100 fine-needle aspirations (FNAs), 58 mammograms, and 31 biopsies were performed. In total, 6,031 were exonerated from cancer, 78 were lost to follow-up (67 for ≤ 50 years and 11 for > 50 years), and 11 were diagnosed with cancer (five for 41-50 years and six for > 50 years, 10 presented with symptoms). Overall breast cancer prevalence was calculated to be 18/10,000 (95% CI, 8 to 29/10,000). The number of women examined per breast cancer diagnosis was 237 (95% CI, 126 to 1910) for women of age 41-50 years and 196 (95% CI, 109 to 977) for women of age > 50 years. Median time to diagnosis for all women was 17.5 [1 to 32.5] days. CBE-detected tumors were not different than tumors presenting through standard care. CONCLUSION In a previously unscreened population, yield from community-based CBE screening was high, particularly among symptomatic women, and required modest diagnostic resources. This strategy has potential to reduce breast cancer mortality.
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Affiliation(s)
- Michael Dykstra
- Beth Israel Deaconess Medical Center, Boston, MA.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Brighid Malone
- Bokamoso Private Hospital, Gaborone, Botswana.,Journey of Hope Botswana, Gaborone, Botswana
| | | | | | | | - Shekinah Elmore
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | | | - Neo Tapela
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,University of Oxford, Oxford, UK
| | - Scott Dryden-Peterson
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Brigham and Women's Hospital, Boston, MA.,Harvard School of Public Health, Boston, MA
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12
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Megersa BS, Bussmann H, Bärnighausen T, Muche AA, Alemu K, Deckert A. Community cervical cancer screening: Barriers to successful home-based HPV self-sampling in Dabat district, North Gondar, Ethiopia. A qualitative study. PLoS One 2020; 15:e0243036. [PMID: 33306681 PMCID: PMC7732077 DOI: 10.1371/journal.pone.0243036] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 11/15/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To explore the barriers to successful home-based human papillomavirus (HPV) self-sampling in North Gondar, Ethiopia. METHODS The study participants were women who had previously participated in a community-wide home-based HPV self-sampling pilot study, community health workers, women's development army leaders, and the sample collectors of the home-based HPV self-sampling pilot study. A community based qualitative descriptive study was conducted. We applied purposive and convenience sampling. In total, 47 women participated in the study (in-depth interviews n = 22, four focus group discussions n = 25, 6-7 participants each). The study employed thematic analysis for clustering the emerged themes. RESULTS Husband disapproval was identified as the main barrier to the acceptance of home-based HPV self-sampling. Social influence, lack of knowledge about cervical cancer and screening, lack of health education on cervical cancer and HPV-based screening, feeling healthy, and religious influence were identified as additional barriers. Fear of using Evalyn brush® for self-sampling was found to be the main barrier to the provision of a quality sample. The inability of the sample collectors to check the proper utilization of Evalyn brush® and the difficulty in understanding the instructions did also contribute to the low-quality. Providing health education concerning cervical cancer and HPV self-sapling to women, male involvement in the screening program, and linking the screening service to existing local health facilities were suggested to guarantee the success of home-based HPV self-sampling. CONCLUSIONS Educating women regarding cervical cancer and HPV testing, providing clear instructions on how to collect self-sample, and male involvement in the screening program are prerequisites for a successful implementation of home-based HPV testing. Women empowerment should also be focused to overcome the identified sociocultural barriers. Furthermore, the screening program should guarantee the timely provision of the test results and offering women follow-up examinations and treatment for abnormal findings.
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Affiliation(s)
- Bikila Soboka Megersa
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Hermann Bussmann
- Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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13
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Taghizadeh Asl R, Van Osch L, De Vries N, Zendehdel K, Shams M, Zarei F, De Vries H. The role of knowledge, risk perceptions, and cues to action among Iranian women concerning cervical cancer and screening: a qualitative exploration. BMC Public Health 2020; 20:1688. [PMID: 33176743 PMCID: PMC7656771 DOI: 10.1186/s12889-020-09701-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/14/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Iran has a low incidence but higher rate of death from cervical cancer (CC). The country is in the process of implementing an organized screening program including HPV testing and cytology. Studies show high dropout in continued testing among eligible women. This qualitative study aimed to explore women's awareness regarding CC and CC testing and the role of knowledge, perceived risk, and cues to action in this process. METHOD Through a qualitative study based on the Framework Method, we recruited 81 women aged 25-65 who participated in 15 focus group discussions (FGDs) and two in-depth interviews in Tehran. The interviewees were selected purposefully during January to May 2015 from households belonging to different socioeconomic classes until data saturation. The data were acquired through 11 open-ended questions and 32 related probe questions. All interviews were transcribed and independently analyzed by two researchers (Kappa and agreement testing respectively: 0.77, 97.11%). RESULTS The coded texts were categorized under three themes and 13 subthemes. The three thematic areas referred to knowledge, cues to action, and perceived risks regarding CC and screening. The results showed that women had limited and unspecified knowledge about CC and screening, compounded by misconceptions regarding infection and cancer prevention measures. Social and cultural barriers hindered proper communication between health system/providers and clients and within communities on subjects related to CC and screening. The perceived risk of getting CC was low because of overestimating the role of hereditary factors for CC, difficulty in differentiating between cancer and sexually transmitted infections (STI), and the absence of visible symptoms. CONCLUSION The results indicate a strong need to invest more efforts to improve health education and communication in the current national health program to promote awareness of the need to screen for CC through, for example, establishing correct knowledge and risk perceptions among women. In addition, this intervention should address women's social environment in order to prevent misconceptions being communicated to women.
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Affiliation(s)
- Rahim Taghizadeh Asl
- Cancer Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran
| | - Liesbeth Van Osch
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Nanne De Vries
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Kazem Zendehdel
- Cancer Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran
| | - Mohsen Shams
- School of Health, Yasuj University of Medical Sciences, Pasdaran 15 Blvd., Yasuj, Iran
| | - Fatemeh Zarei
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University(TMU), P.O. Box: 14115-331, Tehran, Iran
| | - Hein De Vries
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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Xiao JB, Ma JQ, Yakefu K, Tursun M. Effect of the SIRT3-AMPK/PPAR pathway on invasion and migration of cervical cancer cells. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:2495-2501. [PMID: 33165440 PMCID: PMC7642722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
SIRT3 is a mitochondrial deacetylation protein that can promote the invasion and migration of cancer cells. We explored the effects of SIRT3 regulation of the AMPK/PPAR signaling pathway on triglycerides and the invasion and metastasis of cervical cancer cells. Immunohistochemical methods were used to detect SIRT3. The expression of AMPK and PPAR proteins in different cervical lesions was analyzed in combination with clinicopathological parameters. qRT-PCR and western blotting were used to determine the expression levels of SIRT3 in the C33a and SiHa cervical cancer cell lines. To observe the effects of altering SIRT3 levels by lentivirus transfection and the consequent changes in AMPK and PPAR protein expression, oil red O staining was used to determine intracellular triglycerides, and scratch assays and Transwell chamber experiments were performed to evaluate cervical cancer cell migration and invasion. Our data indicate that SIRT3, AMPK, and PPAR protein expression levels show an increasing trend with cervical lesion severity and are related to the degree of lymph node metastasis and differentiation; moreover, increased expression of SIRT3 can promote the expression of AMPK and PPAR proteins, is beneficial to the formation of intracellular neutral fat, and enhances the ability of cells to metastasize and invade. Our results suggest that SIRT3 activates AMPK/PPAR signaling pathways involved in cancer lipid metabolism and promotes metastasis and cell invasion.
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Affiliation(s)
- Jin-Bao Xiao
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
| | - Jun-Qi Ma
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
| | - Kailiman Yakefu
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, China
| | - Mikrban Tursun
- Department of Pathology of Medical University of XinjiangUrumqi, China
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Gottschlich A, Ochoa P, Rivera-Andrade A, Alvarez CS, Mendoza Montano C, Camel C, Meza R. Barriers to cervical cancer screening in Guatemala: a quantitative analysis using data from the Guatemala Demographic and Health Surveys. Int J Public Health 2019; 65:217-226. [PMID: 31838575 PMCID: PMC7049547 DOI: 10.1007/s00038-019-01319-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/21/2019] [Accepted: 12/02/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Examine the association between commonly reported barriers to health care, including discordant spoken languages between patients and providers, and reported previous cervical cancer screening. METHODS Data from the nationally representative Guatemala National Maternal and Child Health Survey from the Demographic and Health Surveys Program were used to explore associations between barriers and screening rates nationwide and in high-risk populations, such as rural and indigenous communities. Negative binomial regressions were run accounting for survey sample weights to calculate prevalence ratios. RESULTS 64.0%, 57.5% and 47.5% of women reported ever screening, in the overall, indigenous, and rural populations, respectively. Overall, never screened for cervical cancer was associated with the following health barriers: needing permission, cost, distance, not wanting to go alone, and primary language not spoken by health providers, even after adjustment for age, ethnicity, and literacy. CONCLUSIONS Offering screening programs alone is not enough to reduce the burden of cervical cancer in Guatemala. Measures need to be taken to reduce barriers to health care, particularly in rural areas, where screening rates are lowest.
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Affiliation(s)
- Anna Gottschlich
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Alvaro Rivera-Andrade
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama-INCAP, Guatemala City, Guatemala
| | - Christian S Alvarez
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Carlos Mendoza Montano
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama-INCAP, Guatemala City, Guatemala
| | - Claudia Camel
- Guatemala Ministry of Health and Social Assistance (MSPAS), Guatemala City, Guatemala
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Benski AC, Viviano M, Jinoro J, Alec M, Catarino R, Herniainasolo J, Vassilakos P, Petignat P. HPV self-testing for primary cervical cancer screening in Madagascar: VIA/VILI triage compliance in HPV-positive women. PLoS One 2019; 14:e0220632. [PMID: 31408474 PMCID: PMC6692065 DOI: 10.1371/journal.pone.0220632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/19/2019] [Indexed: 12/02/2022] Open
Abstract
Objective To assess triage compliance and the effect of the time from screening to triage on follow-up among HPV-positive women. Methods We recruited 1232 women in a screening campaign in Madagascar from February to October 2015. In the first period (February–May), HPV tests were performed remotely using the cobas test. In the second period (May–October), testing was performed on-site using the Xpert HPV assay. HPV-positive women were invited for triage with visual inspection with acetic acid (VIA) and Lugol’s iodine (VILI). Systematic biopsy and endocervical brushing were performed on all HPV-positive women for quality control. Three groups were defined according to time from HPV testing to triage invitation for HPV-positive women—Group I: delayed (> 3 months), Group II: prompt (24–48 hours), and Group III: immediate (< 24 hours). Results A total 1232 self-sampled HPV tests were performed in the study period (496 in Group I, 512 in Group II, and 224 in Group III). Participants’ mean age was 43.2 ± 9.3 years. Mean time from screening to VIA/VILI testing was 103.5 ± 43.6 days. Overall HPV prevalence was 28.0%. HPV prevalence was 27.2% in Group I (cobas test), 29.2% in Group 2 (Xpert test), and 26,7% in Group III (Xpert test). The VIA/VILI compliance rate was 77.8% for Group I, 82.7% for Group II, and 95.0% for Group III. Of women undergoing VIA/VILI, 56.3% in Group I and 43.5% in Groups II/III had positive results. Prevalence of cervical intraepithelial neoplasia grade 2 or worse among HPV-positive women was 9.8% for Group I and 6.8% for Groups II/III. Non-adherence was higher among rural women, uneducated women, and women in Group I. Conclusion HPV-positive women with immediate VIA/VILI triage invitation had the best triage compliance. A single-day test and triage strategy is preferred for low-resource settings.
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Affiliation(s)
- Anne-Caroline Benski
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
- Saint Damien Health Center, Ambanja, Madagascar
- * E-mail:
| | - Manuela Viviano
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Rosa Catarino
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
| | | | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
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Olaza-Maguiña AF, De la Cruz-Ramirez YM. Barriers to the non-acceptance of cervical cancer screenings (pap smear test) in women of childbearing age in a rural area of Peru. Ecancermedicalscience 2019; 13:901. [PMID: 30915159 PMCID: PMC6390831 DOI: 10.3332/ecancer.2019.901] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Indexed: 01/27/2023] Open
Abstract
Introduction According to recent statistics, there is a high percentage of refusal of cervical cancer screening using the Pap smear test by women in rural communities in developing countries such as Peru. There are few studies on the reasons to explain said refusal in this country. The objective of this study was to determine the barriers related to the non-acceptance of cervical cancer screening using the Pap smear test in women of childbearing age from a rural Peruvian community. Methods Cross-sectional study, with a total of 892 women of childbearing age from the rural Peruvian community of Marián, Huaraz province, Ancash region, who did not accept screening for cervical cancer using the Pap smear test during their care at the Marián Health Centre. A questionnaire given from September 2017 to April 2018 was used. The information was processed with the statistics programme for social science 22.0 programme, using the Chi-square statistical test. Results For 4–6 years, 52.5% of women refused cervical cancer screening using the Pap smear test. The barriers that showed a statistically significant relationship to the non-acceptance of cervical cancer screening using the Pap test were socio-demographic (age, marital status, education level, occupation and home income) and institutional barriers (counselling for cervical cancer screening, importance of the gender of health personnel administering the screening, history of mistreatment by health personnel, fear or embarrassment of the screening procedure and a delay in sending the results) (p < 0.05); while a history of sexually transmitted infections and a feeling of physical well-being in sexual and reproductive health were the only related reproductive barriers (p <0.05), this was not demonstrated with the age of first sexual activity, number of sexual partners, age of first pregnancy and total number of pregnancies (p > 0.05). Conclusions Socio-demographic and institutional barriers are related to the non-acceptance of cervical cancer screening using the Pap test in women of childbearing age in the rural Peruvian community of Marián, with a lesser emphasis on reproductive barriers. With this in mind, we recommend undertaking broader studies in populations of different age groups, which should be oriented towards the design and application of preventive/promotional programmes by health institutions to promote the participation of community workers with the goal of aiding the identification and control of said barriers, reducing the refusal of cervical cancer screenings by women from rural areas.
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